The sympathetic nervous system in liver disease

Henriksen, Jens H.; Möller, Sören; Ring‐Larsen, Helmer; Christensen, Niels Juel

doi:10.1016/s0168-8278(98)80022-6

Cited by 148 publications

(123 citation statements)

References 121 publications

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“…However, the relative CBV was significantly lower in the cirrhotic group and a normal volume may be relatively reduced if the capacity of the vascular bed is enlarged. A key feature is that the effective blood volume is physiologically reduced and activates volume and baroreceptors, as reflected by the increased sympathetic nervous activity and activated renin-angiotensin-aldosterone system (9,25,27). This is also supported by the finding of an increased arterial central compliance in patients with cirrhosis, as recently reported by our group (8,10,18).…”

Section: Discussionsupporting

confidence: 59%

Central and noncentral blood volumes in cirrhosis: relationship to anthropometrics and gender

Möller¹,

Henriksen²,

Bendtsen

2003

American Journal of Physiology-Gastrointestinal and Liver Physi

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.-The size of the central and arterial blood volume (CBV) is essential in the understanding of fluid retention in cirrhosis. Previously, it has been reported decreased, normal, or increased, but no reports have analyzed CBV with respect to gender and lean body mass. The aim of the present study was by means of an optimized technique to reassess it in a large group of patients with cirrhosis compared with healthy controls and matched controls in relationship to their body dimensions and gender. Eighty-three patients with cirrhosis (male/female, 60:23), 67 patients without liver disease (male/ female, 22:45), and 14 young healthy controls (male/female, 6:8) underwent a hemodynamic investigation with determination of cardiac output, central circulation time, and CBV determined according to kinetic principles. Related to gender, CBV was lower in male cirrhotics (1.48 Ϯ 0.30 liter) than in matched and young controls (1.68 Ϯ 0.33 and 1.72 Ϯ 0.33 liter, respectively; P Ͻ 0.05-0.01). No significant differences in CBV were seen between female cirrhotics and controls. Absolute and adjusted CBVs were lower in the females than in men with cirrhosis (P Ͻ 0.001), and men with cirrhosis had lower absolute and body weight-adjusted CBVs than matched controls (P Ͻ 0.01). Normalized values of CBV (%total blood volume) were significantly lower in patients with cirrhosis (25 Ϯ 4%) than in matched controls (31 Ϯ 7%) and young controls (28 Ϯ 4%; P Ͻ 0.02). CBV correlated significantly with anthropometrics, including lean body mass (r ϭ 0.68-0.82; P Ͻ 0.0001). In conclusion, the CBV of patients with cirrhosis was lower than that of controls when adjusted for body dimensions and gender. There are significant gender differences, and signs of underfilling are more pronounced in male than in female patients. The results emphasize the importance of adjustments of blood volumes for anthropometrics and gender. central circulation time; hyperdynamic circulation; lean body mass; peripheral vasodilatation; portal hypertension; systemic vascular resistance IN PATIENTS WITH CIRRHOSIS, peripheral and splanchnic arterial vasodilatation leads to a hyperdynamic circulation with increased cardiac output (CO) and heart rate and an abnormal distribution of the blood volume (4, 19). The total blood and plasma volumes are increased and abnormally distributed with an increase in the noncentral or peripheral blood volume (2,12,21,23,30). The size of the central and arterial blood volume (CBV), which represents the effective blood volume where baro-and volume receptors are located, has been the subject of debate (7,23,31). According to the peripheral arterial vasodilatation theory, central hypovolemia leads to a baroreceptor-induced activation of fluid-retaining mechanisms and the development of ascites (4, 26). The alternative overflow theory holds that central and peripheral hypervolemia leads to spill-over of fluid into the peritoneal cavity and thereby the formation of ascites (15). When kinetic principles were applied, earlier results from our laboratory...

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Section: Discussionsupporting

confidence: 59%

Central and noncentral blood volumes in cirrhosis: relationship to anthropometrics and gender

Möller¹,

Henriksen²,

Bendtsen

2003

American Journal of Physiology-Gastrointestinal and Liver Physi

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“…Indeed in human cirrhosis, myocardial hypertrophy could be an adaptive response to chronically expanded blood volume, since these patients have sodium and water retention, starting at the pre-ascitic stage of the disease [24,49]: notably at this early stage neuroendocrine overactivity is slight, becoming increasingly more severe as the cirrhotic process progresses [30]. Nevertheless, in previous studies sympathetic nerve outflow has been documented to be already in- creased even in the compensated stage of disease [50,51]: then the sympathetic nervous system could play a key role in the development of left ventricular hypertrophy in cirrhosis, as already clearly reported in hypertension [52].…”

Section: Discussionmentioning

confidence: 99%

“…Diastolic dysfunction, characterized by an altered pattern of transmitral flow due to impaired diastolic relaxation of left ventricle, can be easily assessed by echocardiography and accordingly can be considered as a marker of this condition. As far as diastolic dysfunction is concerned, many etiological factors have been reliably advocated as potential pathogenic agents: notably substances as NO [18][19][20][21], TNF [22], reactive nitrogen species [23], neurohormones [24][25][26][27][28] may well affect heart structure and function along with circulatory overload [24,29] and overactivity of the SNS [30]. Thickening of heart parietal walls has been reported [12,14,17,31], nevertheless the nature of the structural changes underlying diastolic dysfunction has not been clarified so far.…”

Section: Introductionmentioning

confidence: 99%

Heart Function and Myocardial Tissue Characterization in Patients with HCV Related Cirrhosis: Diastolic Dysfunction and Cardiac Hypertrophy

Pozzi¹,

Pizzala²,

Ratti³

et al. 2007

TOGASJ

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Evidence of diastolic dysfunction in cirrhosis contributed to the definition of cirrhotic cardiomyopathy. In 109 patients with chronic HCV infection with or without cirrhosis E/A ratio, a Doppler marker of diastolic dysfunction, was decreased in cirrhotics (0.89 ± 0.03 vs controls 1.21 ± 0.07, p < 0.01) and to a lesser extent in patients with advanced liver fibrosis (1.17 ± 0.07, p < 0.01). Left ventricular parietal wall thickness was increased. The nature of this abnormality in human cirrhosis has not been clarified, animal studies reporting cardiac hypertrophy. To this aim we employed the echocardiographic integrated backscatter (IBS) technique to obtain an indirect estimate of tissue density (decreased when a higher percentage of muscle fibres is present and increased when fibrosis prevails) to provide myocardial tissue characterization in a subset of patients with compensated HCV cirrhosis. The average IBS signal was reduced in cirrhotics at the level of the posterior wall (21.72 ± 1.46 dB versus 30.85 ± 1.40 dB in controls, p < 0.01). Our results confirm diastolic dysfunction in postviral cirrhosis pointing to cardiac hypertrophy as the anatomopathological background in the compensated stage of disease.

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“…Patients with LC have shown enhanced sympathetic nervous system activity, including increases in sympathetic nerve burst frequency and circulating catecholamine concentrations. 13 Because most LC patients do not have hypertension, changes in LC patients may be due to stimulation mediated by baroreceptors and volume receptors, resulting from low AP and reduced central blood volume. 13,14 Therefore, in LC patients, cardiac remodeling may be caused primarily by sympathetic overactivity together with the induction of an autonomic imbalance and relative parasympathetic withdrawal and, finally, with BRS impairment.…”

Section: Discussionmentioning

confidence: 99%

Changes in Cardiovagal Baroreflex Sensitivity Are Related to Increased Ventricular Mass in Patients With Liver Cirrhosis

Song

Kim

Shin

et al. 2012

Circ J

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The sympathetic nervous system in liver disease

Cited by 148 publications

References 121 publications

Central and noncentral blood volumes in cirrhosis: relationship to anthropometrics and gender

Central and noncentral blood volumes in cirrhosis: relationship to anthropometrics and gender

Heart Function and Myocardial Tissue Characterization in Patients with HCV Related Cirrhosis: Diastolic Dysfunction and Cardiac Hypertrophy

Changes in Cardiovagal Baroreflex Sensitivity Are Related to Increased Ventricular Mass in Patients With Liver Cirrhosis

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