Ascites as a marker for the hyperdynamic heart of Laennec's cirrhosis

The purpose of this study was to determine the relation of the circulatory findings of cirrhosis to hepatic decompensation. Twenty individuals with biopsy-proven cirrhosis and 15 aged-matched controls underwent echocardiographic evaluation of cardiac function. Cardiac dimensions and indices derived from echocardiograms were related to various measures of liver decompensation. Cirrhotics had a higher heart rate, left ventricular end-diastolic volume, left ventricular ejection fraction, and cardiac output and a lower mean blood pressure and peripheral resistance than aged-matched subjects. On multiple regression analyses mean blood pressure, peripheral resistance, and cardiac output were all found to be related to estimates of ascites. Also, cirrhotics with ascites had a lower peripheral resistance than those without this finding.

In clinically stable patients with cirrhosis, the presence of ascites indicates an intense vasodilatory state with a hyperdynamic circulation.