Muscle circulation contributes to hyperdynamic circulatory syndrome in advanced cirrhosis

Background/Aims Muscle wasting likely influences blood flow to muscle districts in advanced cirrhosis. Thus, we assessed systemic hemodynamics and femoral artery blood flow corrected by muscle mass of the lower limb in 13 patients (Child-Pugh classes B and C) and 11 healthy controls. Methods Systemic hemodynamics were assessed by transthoracic electrical bioimpedance, femoral artery blood flow by duplex-Doppler and muscle mass by magnetic resonance imaging. Results As expected, patients exhibited increased cardiac index and reduced peripheral vascular resistance. Femoral artery blood flow did not differ between patients and controls. However, when this parameter was indicized by the muscle mass of the lower limb, which was reduced in patients (median: 3391; range: [2546–4793] vs 5118 [3562–7077] cm3, p = 0.0006), it proved almost doubled in patients (91.1 [59.9–119.4] vs 50.5 [38.6–69.8] μl/min cm3; p = 0.0001). Patient femoral blood flow indicized by muscle mass correlated inversely with peripheral vascular resistance (r = −0.65; p = 0.017) and directly with cardiac index (r = 0.57; p = 0.042). Conclusions Vasodilation of muscle districts contributes to the reduced peripheral vascular resistance in advanced cirrhosis. Our findings provide a stronger rationale for the use of non-selective vasoconstrictors to treat hemodynamic-dependent complications of cirrhosis, such as hepatorenal syndrome.