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[Ultrasonic determination of the common carotid and brachial artery blood flow in patients with acute hepatic
Insights
This study reveals altered circulatory dynamics in acute hepatic failure (AHF), with decreased common carotid artery blood flow and elevated resistance, potentially linked to brain edema and intracranial pressure.
Area of Science:
- Cardiology
- Hepatology
- Neurology
Context:
- Acute hepatic failure (AHF) presents complex circulatory disturbances.
- Hemodynamic assessment is crucial for understanding AHF pathophysiology.
- Cerebral involvement is a significant concern in AHF patients.
Purpose:
- To investigate circulatory parameter characteristics in AHF patients.
- To utilize Swan-Ganz catheterization and quantitative flow measurement (QFM).
- To explore the relationship between circulatory changes and neurological status.
Summary:
- AHF patients exhibited increased cardiac index and decreased systemic vascular resistance (Swan-Ganz).
- QFM showed increased brachial artery blood flow (Br.F.) and decreased common carotid artery blood flow (Ca.F.), reducing the Ca.F./Br.F. ratio.
- Common carotid artery resistance (Ca.R.) correlated negatively with brain white matter CT values (edema) and inversely with intracranial pressure (ICP).
Impact:
- Findings suggest elevated ICP contributes to increased Ca.R. in AHF.
- Circulatory parameter normalization correlates with clinical improvement.
- Highlights the link between hepatic failure, cerebral edema, and hemodynamic alterations.
Abstract:
A study was conducted to elucidate characteristics of circulatory parameters in patients with acute hepatic failure (AHF) employing Swan-Ganz catheter method and, in particular, ultrasonic quantitative flow measurement (QFM) system. The following results were obtained: 1) In five AHF patients who received Swan-Ganz catheter examinations, significant increases of cardiac index as well as decreased systemic vessel resistance were observed. 2) QFM in 11 patients with AHF revealed a significant increase of brachial artery blood flow (Br.F.), whereas common carotid blood flow (Ca.F.) was found to be significantly decreased. Thus, ratio of Ca.F./Br.F. showed a marked reduction as compared with that of control patients. 3) Vessel resistances measured by QFM were found to be significantly reduced in brachial artery, whereas markedly elevated in common carotid artery. 4) Those changes of circulatory parameters as described above were found to restore toward normal in parallel with the improvement of clinical features. 5) Vessel resistances of common carotid artery (Ca.R.) of AHF patients showed a significant negative correlation with CT values in the white matter of the brain, being regarded to well represent the degree of brain edema. In addition, in a case of AHF in whom intracranial pressure (ICP) was directly measured, time course of changes in Ca.F. was found to be in "mirror image" with that of ICP. Thus, it is strongly suggested that the increase of Ca.R. may well be induced, at least in part, by the elevated ICP in AHF patients.