Cardiovascular Mapping in Cirrhosis From the Compensated Stage to Hepatorenal Syndrome: A Magnetic Resonance Study
Research output: Contribution to journal › Journal article › Research › peer-review
Standard
Cardiovascular Mapping in Cirrhosis From the Compensated Stage to Hepatorenal Syndrome : A Magnetic Resonance Study. / Danielsen, Karen Vagner; Wiese, Signe; Busk, Troels; Nabilou, Puria; Kronborg, Thit Mynster; Petersen, Claus Leth; Hove, Jens Dahlgaard; Møller, Søren; Bendtsen, Flemming.
In: American Journal of Gastroenterology, Vol. 117, No. 8, 2022, p. 1269-1278.Research output: Contribution to journal › Journal article › Research › peer-review
Harvard
APA
Vancouver
Author
Bibtex
}
RIS
TY - JOUR
T1 - Cardiovascular Mapping in Cirrhosis From the Compensated Stage to Hepatorenal Syndrome
T2 - A Magnetic Resonance Study
AU - Danielsen, Karen Vagner
AU - Wiese, Signe
AU - Busk, Troels
AU - Nabilou, Puria
AU - Kronborg, Thit Mynster
AU - Petersen, Claus Leth
AU - Hove, Jens Dahlgaard
AU - Møller, Søren
AU - Bendtsen, Flemming
N1 - Publisher Copyright: © 2022 Wolters Kluwer Health. All rights reserved.
PY - 2022
Y1 - 2022
N2 - INTRODUCTION:Arterial vasodilation and hyperdynamic circulation are considered hallmarks of the pathophysiological mechanisms of decompensation in cirrhosis. However, detailed characterization of peripheral, splanchnic, renal, and cardiac hemodynamic have not previously been published in a spectrum from healthy stage to advanced decompensated liver disease with hepatorenal syndrome-acute kidney injury (HRS-AKI).METHODS:We included 87 patients with cirrhosis and 27 healthy controls in this prospective cohort study. The population comprised patients with compensated cirrhosis (n = 27) and decompensated cirrhosis (n = 60); patients with decompensated cirrhosis were further separated into subsets of responsive ascites (33), refractory ascites (n = 16), and HRS-AKI (n = 11). We measured portal pressure and assessed regional blood flow by magnetic resonance imaging.RESULTS:Patients with compensated cirrhosis experienced higher azygos venous flow and higher hepatic artery flow fraction of cardiac index than controls (P < 0.01), but other flow parameters were not significantly different. Patients with decompensated cirrhosis experienced significantly higher cardiac index (P < 0.01), higher superior mesenteric artery flow (P = 0.01), and lower systemic vascular resistance (P < 0.001) compared with patients with compensated cirrhosis. Patients with HRS-AKI had the highest cardiac output and lowest renal flow of all groups (P < 0.01 and P = 0.02, respectively). Associations of single hemodynamic parameters were stronger with model for end-stage liver disease than with portal pressure.DISCUSSION:The regional cardiocirculatory changes seem closely linked to clinical symptoms with 3 distinguished hemodynamic stages from compensated to decompensated cirrhosis and, finally, to HRS-AKI. The attenuated renal perfusion despite high cardiac output in patients with HRS-AKI challenges the prevailing pathophysiological hypothesis of cardiac dysfunction as a causal factor in HRS-AKI. Finally, magnetic resonance imaging seems an accurate and reliable noninvasive method to assess hemodynamics and has potential as a diagnostic tool in patients with cirrhosis.
AB - INTRODUCTION:Arterial vasodilation and hyperdynamic circulation are considered hallmarks of the pathophysiological mechanisms of decompensation in cirrhosis. However, detailed characterization of peripheral, splanchnic, renal, and cardiac hemodynamic have not previously been published in a spectrum from healthy stage to advanced decompensated liver disease with hepatorenal syndrome-acute kidney injury (HRS-AKI).METHODS:We included 87 patients with cirrhosis and 27 healthy controls in this prospective cohort study. The population comprised patients with compensated cirrhosis (n = 27) and decompensated cirrhosis (n = 60); patients with decompensated cirrhosis were further separated into subsets of responsive ascites (33), refractory ascites (n = 16), and HRS-AKI (n = 11). We measured portal pressure and assessed regional blood flow by magnetic resonance imaging.RESULTS:Patients with compensated cirrhosis experienced higher azygos venous flow and higher hepatic artery flow fraction of cardiac index than controls (P < 0.01), but other flow parameters were not significantly different. Patients with decompensated cirrhosis experienced significantly higher cardiac index (P < 0.01), higher superior mesenteric artery flow (P = 0.01), and lower systemic vascular resistance (P < 0.001) compared with patients with compensated cirrhosis. Patients with HRS-AKI had the highest cardiac output and lowest renal flow of all groups (P < 0.01 and P = 0.02, respectively). Associations of single hemodynamic parameters were stronger with model for end-stage liver disease than with portal pressure.DISCUSSION:The regional cardiocirculatory changes seem closely linked to clinical symptoms with 3 distinguished hemodynamic stages from compensated to decompensated cirrhosis and, finally, to HRS-AKI. The attenuated renal perfusion despite high cardiac output in patients with HRS-AKI challenges the prevailing pathophysiological hypothesis of cardiac dysfunction as a causal factor in HRS-AKI. Finally, magnetic resonance imaging seems an accurate and reliable noninvasive method to assess hemodynamics and has potential as a diagnostic tool in patients with cirrhosis.
U2 - 10.14309/ajg.0000000000001847
DO - 10.14309/ajg.0000000000001847
M3 - Journal article
C2 - 35916685
AN - SCOPUS:85135597620
VL - 117
SP - 1269
EP - 1278
JO - The American Journal of Gastroenterology
JF - The American Journal of Gastroenterology
SN - 0002-9270
IS - 8
ER -
ID: 323847109