Key result
Patients with cirrhosis exhibited a significantly blunted mean blood pressure response to isolated muscle metaboreflex activation during post-exercise ischemia compared to healthy controls (∆7.2 vs ∆16.1 mmHg, P=0.001).
Why the study?
To test the hypothesis that cardiovascular responses to isolated muscle metaboreflex activation are blunted in patients with cirrhosis.
Does isolated muscle metaboreflex activation elicit a blunted blood pressure response in patients with cirrhosis compared to healthy controls?
Cross-Sectional (n=26)
No
Does isolated muscle metaboreflex activation elicit a blunted blood pressure response in patients with cirrhosis compared to healthy controls?
Absolute Event Rate: 7.2% vs 16.1%
p-value: p=0.001
Patients with cirrhosis exhibit an abnormal muscle metaboreflex activation, leading to a blunted blood pressure response to exercise despite preserved forearm vascular responses.
May reflect autonomic dysregulation in cirrhosis; hypothesis-generating and requires prospective validation.
We sought to test the hypothesis that the cardiovascular responses to isolated muscle metaboreflex activation would be blunted in patients with cirrhosis. Eleven patients with cirrhosis and 15 healthy controls were evaluated. Blood pressure (BP; oscillometric method), contralateral forearm blood flow (FBF; venous occlusion plethysmography), and heart rate (HR; electrocardiogram) were measured during baseline, isometric handgrip at 30% of maximal voluntary contraction followed by postexercise ischemia (PEI). Forearm vascular conductance (FVC) was calculated as follows: (FBF / mean BP) × 100. Changes in HR during handgrip were similar between groups but tended to be different during PEI (controls: Δ 0.5 ± 1.1 bpm vs. cirrhotic patients: Δ 3.6 ± 1.0 bpm, P = 0.057). Mean BP response to handgrip (controls: Δ 20.9 ± 2.7 mm Hg vs. cirrhotic patients: Δ 10.6 ± 1.5 mm Hg, P = 0.006) and PEI was attenuated in cirrhotic patients (controls: Δ 16.1 ± 1.9 mm Hg vs. cirrhotic patients: Δ 7.2 ± 1.4 mm Hg, P = 0.001). In contrast, FBF and FVC increased during handgrip and decreased during PEI similarly between groups. These results indicate that an abnormal muscle metaboreflex activation explained, at least partially, the blunted pressor response to exercise exhibited by cirrhotic patients. Novelty: Patients with cirrhosis present abnormal muscle metaboreflex activation. BP response was blunted but forearm vascular response was preserved. HR response was slightly elevated.
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Mira et al. (2020) conducted a cross-sectional in Cirrhosis (n=26). Cirrhosis vs. Healthy controls was evaluated on Mean blood pressure response to post-exercise ischemia (PEI) (p=0.001). Patients with cirrhosis exhibited a significantly blunted mean blood pressure response to isolated muscle metaboreflex activation during post-exercise ischemia compared to healthy controls (∆7.2 vs ∆16.1 mmHg, P=0.001).
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