Prevalence of hyperdynamic circulation in cirrhosis: lack of association to presence and severity of ascites

Patients with cirrhosis develop hyperdynamic circulation with an increase in cardiac output (CO) and a decrease in systemic vascular resistance (SVR). Patients with hyperdynamic circulation can develop circulatory dysfunction(CD) when this compensatory mechanism is insufficient. Although this takes place theoretically in decompensated patients, namely in patients with ascites, its prevalence has never been specifically analysed. The aim was to evaluate the prevalence of hyperdynamic circulation in patients with compensated and decompensated cirrhosis and it association to liver function, portal hypertension and CD.

Methods: Secondary analysis of a prospectively collected dataset of patients with cirrhosis who underwent a hepatic hemodynamic study and right heart catheterization. SVR and CO were categorized according to the presence of abnormal values (below 800 dyn.cm.s5 and above 8 l/m, respectively). Hyperdynamic circulation was defined when both parameters were abnormal. CD was defined by the presence of creatinin > 1.5 mg/dL and/or hyponatremia < 130 mmol/L. Variables are reported as percentages or medians(IQR). Comparison were performed by means of U-mann Whitney and ANOVA. Kaplan-Meyer curves were constructed and compared with the log rank test.

Results: 437 patients were included (65% male, 71% had alcohol related disease, Child A 102 (23%), B 182 (42%), and C 130 (30%), 57% with ascites (n= 249) and 30% with refractory ascites (n= 130). 22% had hyperdynamic circulation, interestingly 18% of patients without ascites and 25% of patients with ascites had hyperdynamic circulation. Patients with hyperdynamic circulation had greater HVPG [18 (13 – 20) mmHg vs. 16 (11 – 19) mmHg](p = 0.007) although no difference in creatinin and serum sodium were observed compared to patients without hyperdynamic circulation. Among patients with ascites, no difference in the prevalence of hyperdynamic circulation was observed according to the presence of diuretic responsive (26%) or refractory ascites (23%). CD was observed in 20% of patients, most frequently in patients with refractory ascites (61%). No association was observed between the presence of hyperdynamic circulation and CD. Patients with CD had greater HVPG [19 (16 – 21) mmHg vs 15 (11 – 19) mmHg](p < 0.001) and lower SVR [834 (683 – 1057) dyn.cm.s-5 vs. 938 (751 – 1182) dyn.cm.s-5] (p = 0.006), nevertheless no differences in CO [6.9 (5.6 – 8.4) l/min vs. 6.7 (5.7 – 8.3) l/min] were observed.

Conclusions: Approximately 25% of patients with cirrhosis have hyperdynamic circulation, irrespective of ascites. CD is associated to refractory ascites. Patients with CD have lower SVR, without differences in CO.

Corresponding author: Ripoll, Cristina

E-Mail: cristina_ripoll@yahoo.es