SYSTEMIC HEMODYNAMICS AND SERUM NITRATE LEVELS IN PATIENTS UNDERGOINGENDOSCOPIC VARICEAL LIGATION

The effects of endoscopic variceal ligation (EVL) on systemic hemodyna mics are unknown, This study was conducted to determine whether the ob literation of portal-systemic collaterals by EVL affects systemic hemo dynamics and serum nitrate concentrations in patients with compensated cirrhosis. We measured systemic and hepatic hemodynamics, azygos vein blood flow (AzBF), and serum nitrate concentrations before and immedi ately following EVL. A prompt decrease in left ventricular end-diastol ic volume (LVEDV), stroke volume, cardiac index (CD, and an increase i n systemic vascular resistance index (SVRI) were observed following va riceal Ligation. The reduction in LVEDV was associated with a decline in CI with a rise in SVRI. There was also a prompt reduction in serum nitrate concentration following variceal Ligation. AzBF also significa ntly decreased following variceal ligation. These findings indicate th at EVL decreased cardiac output via a reduction in cardiac preload (ce ntral venous return), Blood how through portal-systemic collaterals ha s an important role in the enhanced cardiac preload of cirrhotic patie nts, The sudden decrease in serum nitrate concentrations suggests that endogenous nitric oxide may be involved in the regulation of systemic hemodynamics in patients with compensated cirrhosis.