Increased arterial compliance in decompensated cirrhosis

Background/Aims: In patients with cirrhosis, the systemic circulation is hy perdynamic with low arterial blood pressure and reduced systemic vascular r esistance. The present study was undertaken to estimate the compliance of t he arterial tree in relation to severity of cirrhosis, circulating level of the vasodilator, calcitonin gene-related peptide (CGRP) and mean arterial blood pressure (MAP). Methods: Arterial compliance (COMPart=Delta V/Delta P) was determined as th e stroke volume relative to pulse pressure (i.e. systolic minus diastolic b lood pressure) during a haemodynamic evaluation of portal hypertension in p atients with biopsy-verified cirrhosis (Child-Turcotte classes A/B/C=10/15/ 6). Results: COMPart was significantly higher in cirrhotic patients (n=31) than in controls (n=10) (1.44 vs 1.00 . 10(-3) 1/mm Hg, p<0.01). It increased s ignificantly through the Child-Turcotte classes A, B, and C (1.02, 1.47, an d 2.1 . 10(-3) l/mmHg, respectively, p=0.03). The stroke volume did not cha nge significantly with the severity of the disease, but pulse pressure decr eased through class A, B, and C (79, 65, and 50 mm Hg, respectively, p<0.01 ). COMPart was slightly, but significantly correlated to the circulating le vel of CGRP (p=0.34, p<0.05), and a substantial but inverse correlation was present to MAP (r= -0.63, p<0.002). Conclusions: Elevated arterial compliance in cirrhosis is directly related to the severity of the disease and to the elevated level of circulating vas odilator peptide CGRP and inversely related to the level of arterial blood pressure. The altered static and dynamic functions of the arterial wall in cirrhosis may have implications for the circulatory and homoeostatic derang ement, and potentially for therapy with vasoactive drugs.