Hepatic arterial flow volume and reserve in patients with cirrhosis: Use of intra-arterial Doppler and adenosine infusion

Abstract

Background & Aims: In cirrhosis, liver blood flow becomes increasingly dependent on the hepatic artery. The aim of this study was to investigate hepatic arterial blood flow volume and resistance and hepatic arterial flow reserve in relation to liver function and systemic hemodynamic alterations in patients with cirrhosis. Methods: In 38 patients with cirrhosis, liver function, cardiac output, and systemic vascular resistance were studied, and hepatic arterial blood flow velocity, flow volume, and pulsatility index at baseline and during intra-arterial administration of adenosine (2–40 μg · min −1 · kg body wt −1) were assessed by angiography combined with intravascular Doppler flowmetry. Results: Hepatic arterial flow velocity was 21 ± 11, 31 ± 17, and 41 ± 27 cm/s; flow volume was 266 ± 246, 342 ± 289, and 417 ± 220 mL/min; and pulsatility index was 2.2 ± 0.7, 1.7 ± 0.6, and 1.5 ± 0.5 in Child–Pugh classes A, B, and C, respectively (differences not statistically significant). Adenosine-induced changes in these parameters were more marked in Child–Pugh class A (68 ± 15 cm/s, 1246 ± 486 mL/min, and −1.14 ± 0.5) than in class C (45 ± 23, P < 0.05;704 ± 492, P = 0.02; and −0.58 ± 0.38, P < 0.05). Using analysis of variance, cardiac index, systemic vascular resistance, and ascites, but not Child–Pugh class, were related to baseline values and adenosine-induced changes. Conclusions: Adenosine is a potent dilator of the hepatic artery in humans. The data suggest that hepatic arterial blood flow and adenosine-dependent flow reserve in patients with cirrhosis are under systemic hemodynamic or neurohormonal control. GASTROENTEROLOGY 1999;116:906-914