CARDIOVASCULAR STATUS AFTER POSTURAL CHANGE IN COMPENSATED CIRRHOSIS - AN ARGUMENT FOR VASODILATORY CONCEPT

It seems that hypervolemia and vasodilatation coincide in compensated cirrhosis, but neither rank nor importance of these factors has been f ully clarified in adaptive response to postural change. We studied, wi th gated equilibrium radionuclide angiography and thoracic electrical bioimpedance the hemodynamic status of 19 patients with compensated ci rrhosis and 18 healthy subjects in upright and supine positions. In th e upright position, the cirrhotic patients were hypotensive and had de creased peripheral vascular resistance despite increased cardiac outpu t. The transition to the supine position was accompanied by a signific ant fall in the heart rate and an increase in the stroke volume in bot h controls (92+/-22 to 63+/-10 beats/min, and 38+/-9 to 62+/-19 ml/m(2 ), respectively) and cirrhotic patients (101+/-20 to 79+/-13 beats/min , and 44+/-15 to 63+/-19 ml/m(2), respectively). Besides, the diastoli c arterial pressure fell in controls from 89+/-9 mmHg to 81+/-11 mmHg; p <0.01, while it remained unchanged in cirrhotic patients (77+/-17 v s 82+/-13 mmHg). In the supine position, the cirrhotic patients presen ted tachycardia and left ventricular hyperkinesy (increased velocity o f left ventricular filling and emptying). In conclusion, these results show that in compensated cirrhosis the decreased arterial tone and pe ripheral blood pooling are important factors of adaptive hemodynamic r eaction to postural change.