Endothelial and microvascular function in liver cirrhosis: an old concept that needs re-evaluation?

Area of Science:

• Cardiovascular Physiology
• Hepatology
• Medical Technology

Background:

• Liver cirrhosis presents complex circulatory dysregulation, primarily involving nitric oxide imbalance.
• While macrovascular changes are documented, peripheral microcirculation and endothelial function in cirrhosis remain less understood.
• Endothelial dysfunction, an imbalance of vasoactive factors, is a key feature.

Purpose of the Study:

• To review functional methods for assessing peripheral microvascular and endothelial function.
• To discuss current evidence regarding circulatory dysfunction in liver cirrhosis patients.
• To highlight advancements in noninvasive assessment techniques.

Main Methods:

• Traditional methods like venous occlusion plethysmography and flow-mediated dilatation (FMD) have limitations.
• Emerging noninvasive techniques include near-infrared spectroscopy, laser speckle contrast imaging, peripheral arterial tonometry, optical coherence tomography, and nailfold video-capillaroscopy.
• These newer methods offer advantages for evaluating peripheral microvascular function.

Main Results:

• Existing studies on endothelial function in cirrhosis using FMD yield contradictory results.
• Noninvasive methods have increasingly demonstrated their utility and advantages in assessing microvascular function.
• Circulatory dysfunction is a significant, though complex, aspect of liver cirrhosis.

Conclusions:

• Peripheral microvascular and endothelial dysfunction are critical components of circulatory alterations in liver cirrhosis.
• Advancements in noninvasive technologies are improving the assessment of these functions.
• Further research is needed to clarify the role and management of microcirculatory dysfunction in cirrhosis.