Systemic hemodynamics, vasoactive systems, and plasma volume in patients with severe Budd-Chiari syndrome
| Autor: | Eric López, Juan Carlos García-Pagán, Juan G. Abraldes, Carlos Piera, Jaime Bosch, Pablo Bellot, Manuel Hernández-Guerra, Juan Turnes |
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| Rok vydání: | 2005 |
| Předmět: |
Adult
Male Cardiac output medicine.medical_specialty Cirrhosis Cardiac index Budd-Chiari Syndrome Plasma renin activity Renin-Angiotensin System chemistry.chemical_compound Internal medicine medicine Humans Cardiac Output Plasma Volume Aged Aldosterone Hepatology business.industry Hemodynamics Middle Aged medicine.disease Endocrinology medicine.anatomical_structure Hematocrit chemistry Vascular resistance Cardiology Portal hypertension Female Vascular Resistance Liver function Portasystemic Shunt Transjugular Intrahepatic business |
| Zdroj: | Hepatology. 43:27-33 |
| ISSN: | 1527-3350 0270-9139 |
| DOI: | 10.1002/hep.20990 |
| Popis: | Budd-Chiari syndrome (BCS) causes postsinusoidal portal hypertension, which leads to complications similar to those observed in cirrhosis. However, no studies have investigated whether patients with BCS develop the hyperdynamic circulatory syndrome present in patients with cirrhosis who have portal hypertension. We evaluated systemic and cardiopulmonary hemodynamics, plasma renin activity, aldosterone and norepinephrine levels, and plasma volume in patients with BCS admitted for complications of portal hypertension. BCS patients had mean systemic and cardiopulmonary pressures and cardiac indices that were within the normal range but were significantly different from those of a group of patients with cirrhosis matched by sex, body surface, and liver function (cardiac index 3.1 +/- 0.7 vs. 4.9 +/- 1.2 L.min(-1).m(-2); P < .001; systemic vascular resistance [SVR] index, 2,189 +/- 736 vs. 1,377 +/- 422 dyne.s.cm(-5).m(-2), P < .001). Despite normal systemic vascular resistance, BCS patients had activation of the neurohumoral vasoactive systems, as evidenced by increased plasma renin activity, aldosterone and norepinephrine levels (15.0 +/- 21.5 ng/mL . h, 76.7 +/- 106.8 ng/dL, 586 +/- 868 pg/mL; respectively) and plasma volume expansion. The analysis of individual BCS patients identified that 7 of the 21 patients actually had reduced SVR index. These patients had the greatest plasma volume expansion. A significant inverse correlation between plasma volume and SVR index was observed. In conclusion, patients with BCS had activation of vasoactive neurohumoral systems and expanded plasma volume. This outcome was observed even though most of these patients did not exhibit systemic vasodilation and cardiac output was not increased, in marked contrast with what is observed in patients with cirrhosis. |
| Databáze: | OpenAIRE |
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