Autonomic dysfunction and hyperdynamic circulation in cirrhosis with ascites

Patients with advanced cirrhosis frequently show hemodynamic abnormalities. Autonomic dysfunction (AD) is also common and, owing to the importance of autonomic function in cardiovascular homeostasis, it may be involved in the pathogenesis of the hyperdynamic circulation. We, therefore, evaluated the hemodynamic status and autonomic function in 30 patients with cirrhosis, m ost of them with an advanced stage of the disease. Autonomic function was a ssessed with 7 cardiovascular tests exploring the vagal or sympathetic func tion. Each test was scored from 1 to 3 (normal, borderline, altered). Cardi ac index (CI) was measured by an echocardiogram. Twenty-four (80%) patients showed an AD, this being definite in 14 (47%) patients. A vagal dysfunctio n (VD) was found in 19 patients (63%), this being definite in II patients ( 37%), and a sympathetic dysfunction (SD) in 7 patients (definite in 3 [10%] patients). The patients with AD showed a faster heart rate (P = .021), low er indicized peripheral vascular resistance (P = .013), and increased CI (P = .004) than patients without AD whereas mean arterial pressure did not di ffer. Similar results were seen by grouping patients according to the VD, A D score was directly correlated with heart rate (r = 0.53; P = .002) and CI (r = 0.45; P = .016), and inversely correlated with peripheral vascular re sistance (r = 0.46; P = .013), Even closer correlations were found with vag al score. AD (mainly VD) may be involved in the pathogenesis of the hyperdy namic circulatory syndrome of patients with advanced cirrhosis.