The cardiac response to exercise in cirrhosis

• Published in: Gut Vol. 49; no. 2; pp. 268 - 275
• Main Authors: Wong, F, Girgrah, N, Graba, J, Allidina, Y, Liu, P, Blendis, L
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Society of Gastroenterology 01.08.2001; BMJ; BMJ Publishing Group Ltd; BMJ Publishing Group LTD
• Subjects: Alcohol; Analysis of Variance; Ascites - diagnostic imaging; Ascites - etiology; Ascites - physiopathology; Biological and medical sciences; Biopsy; Body mass index; Cardiomyopathies - diagnostic imaging; Cardiomyopathies - etiology; Cardiomyopathies - physiopathology; Cardiomyopathy; Cardiovascular disease; Cardiovascular system; Case-Control Studies; Causes of; cirrhosis; Complications and side effects; Echocardiography; Exercise; Exercise Test - methods; exercise tolerance; Exercise Tolerance - physiology; Female; Heart; Heart diseases; Hepatitis; Hospitals; Humans; Investigative techniques, diagnostic techniques (general aspects); Liver cirrhosis; Liver Cirrhosis - complications; Liver Cirrhosis - diagnostic imaging; Liver Cirrhosis - physiopathology; Male; Measurement; Medical sciences; Middle Aged; Musculoskeletal system; myocardial function; Nitric oxide; Oxygen consumption; Oxygen Consumption - physiology; Physiological aspects; Radionuclide Imaging; Radiopharmaceuticals; Regression Analysis; Rodents; Sodium Pertechnetate Tc 99m; Stroke Volume; Transplants & implants; Ultrasonic imaging; Ultrasonic investigative techniques; Canada; Sonography; Physical exercise; Human; Echocardiography; Radiodiagnosis; Tolerance test; Physical performance; Functional response; Hepatic disease; Cardiopulmonary; Oxygen consumption; Cirrhosis; Athletics; Association; Capacity; Myocardium; Digestive diseases; Medical imagery
• ISSN: 0017-5749; 1468-3288; 1458-3288
• DOI: 10.1136/gut.49.2.268

BACKGROUND Impaired exercise capacity and oxygen consumption are common in cirrhosis. AIM To explore the relationship between possible myocardial dysfunction and exercise tolerance in cirrhosis. METHODS Cardiac responses to exercise, using radionuclide angiography and graded upright cycle ergometry with oxygen consumption, were assessed before and after exercise in 39 cirrhotics patients and compared with 12 age and sex matched healthy volunteers. Baseline cardiac chamber dimensions and wall thickness, ejection fraction, and diastolic function were measured using two dimensional echocardiography is all subjects. RESULTS Baseline diastolic dysfunction with prolonged isovolumic relaxation times (p=0.02), left atrial enlargement, and left ventricular wall thickening were present in all cirrhotics (p=0.02), despite increased mean ejection fraction. With graded exercise, cirrhotics achieved 71 (4)% (p=0.03) (pre-ascitics) and 46 (3)% (p<0.001) (ascitics) of predicted work loads, respectively, without significant increases in ejection fraction. The smaller absolute and percentage increases in cardiac output (p=0.003) in the cirrhotics were associated with significantly reduced oxygen consumption (p=0.003) and anaerobic threshold (p<0.001), and correlated significantly with work and metabolic parameters. CONCLUSIONS Impaired exercise capacity in cirrhosis is associated with myocardial thickening and ventricular stiffness leading to decreased diastolic function, inotropic and chronotropic incompetence under conditions of stress, with metabolic consequences. This picture is compatible with the condition now known as cirrhotic cardiomyopathy.