EXERCISE-INDUCED LEFT-VENTRICULAR DYSFUNCTION IN ALCOHOLIC AND NONALCOHOLIC CIRRHOSIS

Background/Aims: Autonomic and cardiac dysfunction have been reported in patients with cirrhosis, We studied left ventricular and autonomic function in 20 patients with both alcoholic and non-alcoholic cirrhosis. Methods: Autonomic function was assessed by a standard battery of cardiovascular reflex tests, Supine exercise radionuclide ventriculography was used to assess the cardiac response to exercise. Results: Exercise capacity was reduced in all patients in association with marked chronotropic incompetence (peak heart rates 120.5+/-6 bpm), Unlike normal subjects there was no increase in left ventricular ejection fraction on exercise, Stroke volume increased by 23+/-6%, mediated by an increase in end-diastolic volume of >20%, Cardiac output was subnormal at maximal exercise, increasing by only 96+/-14% and 97+/-11% in alcoholic and non-alcoholic groups respectively, The majority (83%) of our patients had autonomic reflex abnormalities. Conclusions: Patients with cirrhosis of alcohol and non-alcohol related aetiologies have significantly impaired cardiovascular responses to exercise, which are similar to those of a denervated heart, This may have important clinical implications for the ability of these patients to withstand cardiovascular stress.