Dahl Emilie Kristine, Møller Søren, Kjær Andreas, Petersen Claus Leth, Bendtsen Flemming, Krag Aleksander
Department of Gastroenterology, Odense University Hospital , Odense , Denmark.
Scand J Gastroenterol. 2014 Mar;49(3):362-72. doi: 10.3109/00365521.2013.867359. Epub 2013 Dec 16.
OBJECTIVE. Presence of cardiac dysfunction in patients with advanced cirrhosis is widely accepted, but data in early stages of cirrhosis are limited. Systolic and diastolic functions, dynamics of QT-interval, and pro-atrial natriuretic peptide (pro-ANP) are investigated in patients with early stage cirrhosis during maximal β-adrenergic drive. MATERIAL AND METHODS. Nineteen patients with Child A (n = 12) and Child B cirrhosis (n = 7) and seven matched controls were studied during cardiac stress induced by increasing dosages of dobutamine and atropine. RESULTS. Pharmacological responsiveness was similar in cirrhosis and controls and the heart rate (HR) increased by 66 ± 15 versus 67 ± 8 min(-1). HR-blood pressure product increased equally by 115% in both cirrhotic patients and controls. However, time to resume HR of 100 beats/min was significantly longer in cirrhosis, p < 0.01. The QTc interval increased after dobutamine infusion in cirrhosis (0.41 ± 0.02 vs. 0.43 ± 0.02 s, p = 0.001) but similar electrophysiological changes were seen in controls. Cardiac volumes increased with the severity of disease. The increased cardiac output was primarily attributed to increased stroke volume. The ejection fraction was similar in patients and controls. Peak filling rate was longer in cirrhosis compared to controls (1.8 ± 0.4 and 1.4 ± 0.2 end-diastolic volume/s, p < 0.01). Pro-ANP was higher in cirrhosis and increased during stress by 13% compared to 0% in controls, p < 0.01. CONCLUSIONS. These findings indicate that patients with early stage cirrhosis exhibit early diastolic and autonomic dysfunction as well as elevated pro-ANP. However, the cardiac chronotropic and inotropic responses to dobutamine stress were normal. The dynamics of ventricular repolarization appears normal in patients with early stage cirrhosis.
目的。晚期肝硬化患者存在心脏功能障碍已被广泛认可，但肝硬化早期的数据有限。本研究对早期肝硬化患者在最大β-肾上腺素能驱动状态下的收缩和舒张功能、QT间期动态变化以及心钠素原（pro-ANP）进行了研究。材料与方法。对19例Child A级（n = 12）和Child B级肝硬化（n = 7）患者以及7例匹配的对照者，在通过递增剂量的多巴酚丁胺和阿托品诱导心脏应激的过程中进行了研究。结果。肝硬化患者和对照者的药理反应相似，心率（HR）分别增加了66 ± 15次/分钟和67 ± 8次/分钟。肝硬化患者和对照者的心率-血压乘积均同样增加了115%。然而，肝硬化患者恢复至100次/分钟心率的时间明显更长，p < 0.01。多巴酚丁胺输注后，肝硬化患者的QTc间期增加（0.41 ± 0.02秒对0.43 ± 0.02秒，p = 0.001），但在对照者中也观察到了类似的电生理变化。心脏容积随疾病严重程度增加。心输出量增加主要归因于每搏输出量增加。患者和对照者的射血分数相似。与对照者相比，肝硬化患者的峰值充盈率更长（分别为1.8 ± 0.4和1.4 ± 0.2舒张末期容积/秒，p < 0.01）。肝硬化患者的心钠素原水平更高，应激期间增加了13%，而对照者增加了0%，p < 0.01。结论。这些发现表明，早期肝硬化患者表现出早期舒张功能和自主神经功能障碍以及心钠素原升高。然而，对多巴酚丁胺应激的心脏变时性和变力性反应正常。早期肝硬化患者的心室复极动态变化似乎正常。
