[논문]Cardiovascular and renal function in normotensive and hypertensive patients with compensated cirrhosis: effects of posture

Gentilini, Paolo; Romanelli, Roberto Giulio; Laffi, Giacomo; Barletta, Giuseppe; Bene, Riccarda Del; Messeri, Gianni; Villa, Giorgio La

doi:10.1016/S0168-8278(99)80193-7

[해외논문] Cardiovascular and renal function in normotensive and hypertensive patients with compensated cirrhosis: effects of posture

Journal of hepatology : the journal of the European Association for the Study of the Liver, v.30 no.4, 1999년, pp.632 - 638

Gentilini, Paolo (Paolo Gentilini, Istituto di Medicina Interna, Viale Morgagni 85, 50134 Florence, Italy. Tel: 39 55 416635. Fax 39 55 417123.) , Romanelli, Roberto Giulio (Istituto di Medicina Interna, Istituto di Clinica Medica e Cardiologia, University of Florence School of Medicine, Azienda Ospedaliera Careggi, Florence, Italy) , Laffi, Giacomo (Istituto di Medicina Interna, Istituto di Clinica Medica e Cardiologia, University of Florence School of Medicine, Azienda Ospedaliera Careggi, Florence, Italy) , Barletta, Giuseppe (Istituto di Medicina Interna, Laboratorio di Endocrinologia, Azienda Ospedaliera Careggi, Florence, Italy) , Bene, Riccarda Del , Messeri, Gianni , Villa, Giorgio La

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AbstractBackground/Aims: The aim of this study was to evaluate cardiovascular and renal function in patients with compensated cirrhosis and essential hypertension in the supine position and in response to standing up.Methods: Twenty-four patients with compensated cirrhosis (12 with elevated arterial pressure) and 20 healthy volunteers underwent echocardiographic evaluation of left ventricular end-diastolic and stroke volumes, ejection fraction, cardiac index, arterial pressure, peripheral resistance, creatinine clearance and sodium excretion in both the supine and the standing position.Results: When supine, only normotensive patients had a hyperdynamic circulation, with increased left ventricular end-diastolic and stroke volumes, cardiac index, and ejection fraction, and reduced peripheral resistance. Creatinine clearance and sodium excretion were comparable in patients and controls. Standing induced a decrease in end-diastolic volume in all subjects. Healthy volunteers maintained cardiovascular homeostasis by increasing ejection fraction and heart rate, while both normotensive and hypertensive cirrhotic patients experienced a fall in stroke volume and cardiac index, despite a marked activation of the renin-aldosterone and sympathetic nervous system. Creatinine clearance decreased only in normotensive patients, who experienced the greatest reduction in sodium excretion.Conclusions: Compensated cirrhotic patients with arterial hypertension had no evidence of hyperdynamic circulation. Like their normotensive counterparts, hypertensive patients had an impaired cardiovascular response to the postural challenge, but a lesser degree of renal dysfunction during standing.

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