Prevalence of Autonomic Dysfunction in Cirrhotic and Noncirrhotic Portal Hypertension

Rangari, Manisha; Sinha, Shalini; Kapoor, Dharmesh; Mohan, Jagdish C.; Sarin, Shiv Kumar

doi:10.1111/j.1572-0241.2002.05551.x

Cited by 48 publications

(8 citation statements)

References 27 publications

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“…[92]. Portal hypertensive gastropathy is relatively less common in NCPF [57] than in cirrhosis and manifests mainly after variceal obliteration. Anorectal varices are more common in NCPF than in cirrhosis.…”

Section: Prevalence Of Varicesmentioning

confidence: 98%

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Noncirrhotic portal fibrosis/idiopathic portal hypertension: APASL recommendations for diagnosis and treatment

et al. 2007

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The Asian Pacific Association for the Study of the Liver (APASL) Working Party on Portal Hypertension has developed consensus guidelines on the disease profile, diagnosis, and management of noncirrhotic portal fibrosis and idiopathic portal hypertension. The consensus statements, prepared and deliberated at length by the experts in this field, were presented at the annual meeting of the APASL at Kyoto in March 2007. This article includes the statements approved by the APASL along with brief backgrounds of various aspects of the disease.

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Section: Prevalence Of Varicesmentioning

confidence: 98%

“…Consensus statements Left upper quadrant pain due to perisplenitis and splenic infarction is not uncommon [53]. Like cirrhosis, NCPF also may have odd presentations, such as glomerulonephritis [54,55], hypoxemia [56], or autonomic dysfunction [57]. [7].…”

Section: Repeated Low-dose Endotoxemia Of Portal Circulationmentioning

confidence: 99%

Noncirrhotic portal fibrosis/idiopathic portal hypertension: APASL recommendations for diagnosis and treatment

et al. 2007

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“…Since the autonomic nervous system directly innervates the hepatic parenchyma and has a role in metabolic control [3], it seems likely that liver regeneration and apoptosis are cooperatively regulated by both humoral factors and the autonomic nervous system. Moreover, it is well known that autonomic abnormalities and neuropathy tend to increase with age [4]. The prevalence and severity of autonomic dysfunction appears to be related to the severity of liver disease and is associated with an increase in mortality [5, 6].…”

Section: Introductionmentioning

confidence: 99%

The Role of the Autonomic Nervous System in Liver Regeneration and Apoptosis – Recent Developments

Kiba

2002

Digestion

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Hepatocytes have a great replicative capacity and are capable of repopulating the liver. Previous studies have suggested that the autonomic nervous system regulates liver regeneration and apoptosis. Moreover, the central nervous system modulates them through the autonomic nervous system. The lateral hypothalamus (LH) area and the ventromedial hypothalamus (VMH) nucleus have been studied for their role in the integration of neurohumoral information. The LH is part of the parasympathetic system, while the VMH belongs to the sympathetic system. Lesions of the LH reportedly induced an increase in sympathetic nerve activity, while those in the VMH produced facilitation of vagus nerve activity. Moreover, VMH or LH lesions facilitate hepatic regeneration after partial hepatectomy. Furthermore, the hypothalamus mediates hepatic apoptosis through the autonomic nervous system. Although further studies are needed to define the role clearly, the autonomic nervous system is one of the important factors that regulate liver regeneration and apoptosis.

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“…Vagal afferent and efferent fibers also innervate the portal vein, hepatic arteries, and biliary ducts in addition to liver parenchyma 24. Specifically, autonomic dysfunction has been observed in the setting of portal hypertension1, 2, 3 and nonalcoholic fatty liver disease,25 and denervation of liver parenchyma has been observed in cirrhosis 26. Cardiac metaiodobenzylguanidine studies have shown an increased washout rate consistent with abnormal myocardial norepinephrine reuptake in patients with cirrhosis.…”

Section: Discussionmentioning

confidence: 99%

“…Liver disease can affect circulating inflammatory peptides and lead to autonomic dysfunction, creating a proarrhythmic substrate 1, 2, 3, 4. An elevated risk of atrial fibrillation (AF) among patients with liver disease and structurally normal hearts seems plausible given that inflammation and autonomic dysfunction have been shown to contribute to pathogenesis of AF 5.…”

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confidence: 99%

Liver Disease as a Predictor of New‐Onset Atrial Fibrillation

Huang

Dunipace

Sorg

et al. 2018

JAHA

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BackgroundImpact of liver disease on development of atrial fibrillation (AF) is unclear. The purpose of the study was to evaluate prevalence of AF in the setting of liver disease and whether increasing severity of liver disease, using Model for End‐Stage Liver Disease (MELD), is independently associated with increased risk of AF.Methods and ResultsRetrospective data analysis of 1727 patients with liver disease evaluated for liver transplantation between 2006 and 2015 was performed, and patient characteristics were analyzed from billing codes and review of medical records. Multivariable time‐dependent Cox proportional hazards model was performed to determine effect of increasing MELD score on risk of developing AF. Prevalence of AF was 11.2%. Incidence of AF at median follow‐up time of 1.04 years was 8.5%. Both prevalence and incidence of AF increased with increasing MELD scores. Prevalence of AF was 3.7%, 6.4%, 16.7%, and 20.2% corresponding with MELD quartiles 1 to 10, 11 to 20, 21 to 30, and >30, respectively. Compared with patients with MELD quartile 1 to 10, patients with MELD quartile of 11 to 20 had hazard ratio of 2.73 (confidence interval, 1.47–5.07), those in the MELD quartile of 21 to 30 had a hazard ratio of 5.17 (confidence interval, 2.65–10.09), and those with MELD values >30 had hazard ratio of 9.33 (confidence interval, 3.93–22.14) for development of new‐onset AF. Other significant variables associated with new‐onset AF were age, sleep apnea, valvular heart disease, hemodynamic instability, and reduced left ventricular ejection fraction <50% (hazard ratio, of 1.06, 2.17, 3.21, 2.00, and 2.44, respectively).ConclusionsPrevalence and incidence of AF in patients with liver disease is high. Severity of liver disease, as measured by MELD, is an important predictor of new‐onset AF. This novel finding suggests an interaction between inflammatory and neurohormonal changes in liver disease and pathogenesis of AF.

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Prevalence of Autonomic Dysfunction in Cirrhotic and Noncirrhotic Portal Hypertension

Abstract: Autonomic dysfunction is frequently encountered in patients with EHPVO and cirrhosis, and the presence of autonomic dysfunction in patients with noncirrhotic portal hypertension suggests a primary role of portal hypertension per se in the dysfunction.

Cited by 48 publications

References 27 publications

Noncirrhotic portal fibrosis/idiopathic portal hypertension: APASL recommendations for diagnosis and treatment

Noncirrhotic portal fibrosis/idiopathic portal hypertension: APASL recommendations for diagnosis and treatment

The Role of the Autonomic Nervous System in Liver Regeneration and Apoptosis – Recent Developments

Liver Disease as a Predictor of New‐Onset Atrial Fibrillation

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