New vasoactive peptides in cirrhosis: organ extraction and relation to the vasodilatory state

Abstract

Background Patients with cirrhosis have substantial circulatory imbalance between vasoconstrictive and vasodilating forces. The study of circulatory vasoactive peptides may provide important pathophysiological information. This study aimed to assess concentrations, organ extraction and relations to haemodynamic changes in the pro-peptides copeptin, proadrenomedullin and pro-atrial natriuretic peptide (proANP) in patients with cirrhosis.

The pathophysiology of arterial vasodilatation and hyperdynamic circulation in cirrhosis

“…As mentioned above, an increased intrahepatic resistance leads to portal hypertension and development of portosystemic shunts . The combination of hepatic failure and portosystemic shunts by‐passing blood away from the liver increases circulating vasodilators such as NO, arachidonic acid metabolites, calcitonin gene‐related peptide (CGRP) and others (Table ) . An augmented vasodilatation increases plasma‐ and blood volumes and cardiac output and lead to a hyperdynamic circulatory state that further increases splanchnic and hepatic inflow .…”

“…In cirrhosis, brain natriuretic peptides (BNP and pro‐BNP) are related to disease severity, cardiac dysfunction (QT‐interval prolongation) and survival . Circulating atrial natriuretic peptides (ANP and pro‐ANP) is increased in decompensated cirrhosis and is related to the progression of liver dysfunction, portal hypertension and imbalance of systemic haemodynamics …”

Use of finger‐piece method for indocyanine green clearance test

“…This could be attributed to the local difference in the ICG concentration between the cubital vein and fingertip. Specifically, clearance of vasodilatory substances such as nitric oxide decreases with the development of liver damage . Thus, the peripheral vascular resistance decreases, and the ICG concentration in the fingertip may be lower than that in the cubital vein.…”

Research update for articles published in EJCI in 2014

“…Appendix Other n = 1 [71] Pro-atrial natriuretic peptide (proANP) is elevated in cirrhosis. Copeptin, proadrenomedullin and proANP are related to portal pressure and seem associated with systemic haemodynamics.…”