Korean J Gastroenterol.  2023 Nov;82(5):209-212. 10.4166/kjg.2023.124.

Hemodynamic Changes in Chronic Liver Disease

• Jo S
• Park K

• KMID: 2548490
• DOI: http://doi.org/10.4166/kjg.2023.124

Abstract

Chronic liver disease causes hemodynamic changes in the body depending on the degree of progression. These hemodynamic changes begin with splanchnic vasodilation, with complications beginning to appear as the hyperdynamic changes occur. As chronic liver disease progresses, increased splanchnic vasodilation and hyperdynamic changes worsen portal hypertension and help cause or worsen chronic liver disease complications, such as ascites. Ultimately, the effective plasma volume and blood pressure decrease in the terminal stage.

Keyword

Liver diseases; Hemodynamics; Splanchnic circulation

Figure

• 

  Fig. 1 Hemodynamic changes according to the stages of chronic liver disease. Hemodynamic changes begin with splanchnic vasodilation. As chronic liver disease progresses, increased splanchnic vasodilation and hyperdynamic changes decrease the effective circulatory volume. ADH, antidiuretic hormone; RAAS, renin-angiotensin-aldosterone system; SNS, sympathetic nervous system.

Reference

1. Raaschou F. 1954; Liver function and hypertension; blood pressure and heart weight in chronic hepatitis. Circulation. 10:511–516. DOI: 10.1161/01.CIR.10.4.511. PMID: 13209737.

2. Iwakiri Y. 2014; Pathophysiology of portal hypertension. Clin Liver Dis. 18:281–291. DOI: 10.1016/j.cld.2013.12.001. PMID: 24679494. PMCID: PMC3971388.

3. Gaiani S, Bolondi L, Li Bassi S, Santi V, Zironi G, Barbara L. 1989; Effect of meal on portal hemodynamics in healthy humans and in patients with chronic liver disease. Hepatology. 9:815–819. DOI: 10.1002/hep.1840090604. PMID: 2653993.

4. Bolognesi M, Di Pascoli M, Verardo A, Gatta A. 2014; Splanchnic vasodilation and hyperdynamic circulatory syndrome in cirrhosis. World J Gastroenterol. 20:2555–2563. DOI: 10.3748/wjg.v20.i10.2555. PMID: 24627591. PMCID: PMC3949264.

5. Parks DA, Jacobson ED. 1985; Physiology of the splanchnic circulation. Arch Intern Med. 145:1278–1281. DOI: 10.1001/archinte.1985.00360070158027.

6. Chang PI, Rutlen DL. 1991; Effects of beta-adrenergic agonists on splanchnic vascular volume and cardiac output. Am J Physiol. 261:H1499–H1507. DOI: 10.1152/ajpheart.1991.261.5.H1499. PMID: 1683172.

7. Battista S, Bar F, Mengozzi G, Zanon E, Grosso M, Molino G. 1997; Hyperdynamic circulation in patients with cirrhosis: direct measurement of nitric oxide levels in hepatic and portal veins. J Hepatol. 26:75–80. DOI: 10.1016/S0168-8278(97)80012-8. PMID: 9148026.

8. Bátkai S, Járai Z, Wagner JA, et al. 2001; Endocannabinoids acting at vascular CB1 receptors mediate the vasodilated state in advanced liver cirrhosis. Nat Med. 7:827–832. DOI: 10.1038/89953. PMID: 11433348.

9. Fernández-Rodriguez CM, Prada IR, Prieto J, et al. 1998; Circulating adrenomedullin in cirrhosis: relationship to hyperdynamic circulation. J Hepatol. 29:250–256. DOI: 10.1016/S0168-8278(98)80010-X. PMID: 9722206.

10. Kim MY, Baik SK, Lee SS. 2010; Hemodynamic alterations in cirrhosis and portal hypertension. Korean J Hepatol. 16:347–352. DOI: 10.3350/kjhep.2010.16.4.347. PMID: 21415576. PMCID: PMC3304610.

11. He FJ, Markandu ND, MacGregor GA. 2001; Importance of the renin system for determining blood pressure fall with acute salt restriction in hypertensive and normotensive whites. Hypertension. 38:321–325. DOI: 10.1161/01.HYP.38.3.321. PMID: 11566898.

12. Lubel JS, Herath CB, Burrell LM, Angus PW. 2008; Liver disease and the renin-angiotensin system: recent discoveries and clinical implications. J Gastroenterol Hepatol. 23:1327–1338. DOI: 10.1111/j.1440-1746.2008.05461.x. PMID: 18557800. PMCID: PMC7166336.

13. Ripoll C, Ibáñez-Samaniego L, Neumann B, et al. 2022; Evaluation of the definition of hyperdynamic circulation in patients with cirrhosis and ascites. Hepatol Commun. 6:3528–3538. DOI: 10.1002/hep4.2102. PMID: 36221228. PMCID: PMC9701480.

14. Better OS, Schrier RW. 1983; Disturbed volume homeostasis in patients with cirrhosis of the liver. Kidney Int. 23:303–311. DOI: 10.1038/ki.1983.20. PMID: 6341682.

15. Newby DE, Hayes PC. 2002; Hyperdynamic circulation in liver cirrhosis: not peripheral vasodilatation but 'splanchnic steal'. QJM. 95:827–830. DOI: 10.1093/qjmed/95.12.827. PMID: 12454326.

16. Sersté T, Melot C, Francoz C, et al. 2010; Deleterious effects of beta-blockers on survival in patients with cirrhosis and refractory ascites. Hepatology. 52:1017–1022. DOI: 10.1002/hep.23775. PMID: 20583214.

17. Ge PS, Runyon BA. 2014; The changing role of beta-blocker therapy in patients with cirrhosis. J Hepatol. 60:643–653. DOI: 10.1016/j.jhep.2013.09.016. PMID: 24076364.

18. Izzy M, VanWagner LB, Lin G, et al. 2020; Redefining cirrhotic cardiomyopathy for the modern era. Hepatology. 71:334–345. DOI: 10.1002/hep.30875. PMID: 31342529. PMCID: PMC7288530.

19. Zardi EM, Abbate A, Zardi DM, et al. 2010; Cirrhotic cardiomyopathy. J Am Coll Cardiol. 56:539–549. DOI: 10.1016/j.jacc.2009.12.075. PMID: 20688208.

20. Bansal S, Lindenfeld J, Schrier RW. 2009; Sodium retention in heart failure and cirrhosis: potential role of natriuretic doses of mineralocorticoid antagonist? Circ Heart Fail. 2:370–376. DOI: 10.1161/CIRCHEARTFAILURE.108.821199. PMID: 19808361.

21. Ryoo JH, Ham WT, Choi JM, et al. 2014; Clinical significance of non-alcoholic fatty liver disease as a risk factor for prehypertension. J Korean Med Sci. 29:973–979. DOI: 10.3346/jkms.2014.29.7.973. PMID: 25045230. PMCID: PMC4101786.

22. Sanyal AJ, Van Natta ML, Clark J, et al. 2021; Prospective study of outcomes in adults with nonalcoholic fatty liver disease. N Engl J Med. 385:1559–1569. DOI: 10.1056/NEJMoa2029349. PMID: 34670043. PMCID: PMC8881985.

23. Henriksen JH, Møller S. 2004; Hypertension and liver disease. Curr Hypertens Rep. 6:453–461. DOI: 10.1007/s11906-004-0041-5. PMID: 15527691.

24. Tandon P, Abraldes JG, Berzigotti A, Garcia-Pagan JC, Bosch J. 2010; Renin-angiotensin-aldosterone inhibitors in the reduction of portal pressure: a systematic review and meta-analysis. J Hepatol. 53:273–282. DOI: 10.1016/j.jhep.2010.03.013. PMID: 20570385.

25. Santos J, Planas R, Pardo A, et al. 2003; Spironolactone alone or in combination with furosemide in the treatment of moderate ascites in nonazotemic cirrhosis. A randomized comparative study of efficacy and safety. J Hepatol. 39:187–192. DOI: 10.1016/S0168-8278(03)00188-0. PMID: 12873814.