Limited cardiac preload reserve in conscious cirrhotic rats

In conscious rats with experimental cirrhosis without ascites, we have studied whether there is a limited cardiac preload reserve by performing cardiac output (CO) curves. CO was determined by thermodilution at basal, 5, 7.5, and 10 cmH2O of right atrial pressure (RAP). RAP was elevated by dextran infusion (1 ml/min iv, 30 min). CO curves were performed by plotting changes in CO with changes in RAP. In the basal state, cirrhotic rats showed a hyperdynamic circulation defined by increased CO and stroke volume, decreased total peripheral resistances, and normotension without changes in heart rate. Blood volume was also elevated in cirrhotic rats compared with the control animals. Between the limits of RAP studied, the CO curve of control rats presented a typical ascending limb. In contrast, the CO curve of the cirrhotic animals showed first an ascending shifted upward limb and afterward a descending limb. These alterations were accompanied by changes in the inotropic state as measured as left ventricular (LV) peak dP/dt in hexamethonium-pretreated animals submitted to the same volume loads described above. With the same increases in RAP, LV dP/dt changed, in every group, in a manner similar to CO. The results of the present study indicate that cirrhotic rats with high blood volume and hyperdynamic circulation show, in the steady state, a limited preload reserve. The partial utilization of the preload reserve can make the cirrhotic heart unable to modulate cardiac performance with changes in loading conditions, thus determining a state of heart failure.