Minimal Hepatic Encephalopathy is Associated with Increased Cerebral Vascular Resistance. A Transcranial Doppler Ultrasound Study
Abstract Minimal hepatic encephalopathy (MHE) is a subclinical complication of liver cirrhosis with a relevant social impact. Thus, there is urgent need to implement easy to use diagnostic tools for the early identification of affected patients. The aim of this study was to investigate cerebral bloo...
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doaj-710579cf4e6f416a9623616f204212422020-12-08T07:32:58ZengNature Publishing GroupScientific Reports2045-23222019-10-01911910.1038/s41598-019-51867-6Minimal Hepatic Encephalopathy is Associated with Increased Cerebral Vascular Resistance. A Transcranial Doppler Ultrasound StudyFrancesca Romana Ponziani0Barbara Funaro1Andrea Lupascu2Maria Elena Ainora3Matteo Garcovich4Gianluigi Caracciolo5Alessandro Quadarella6Antonio Nesci7Laura Riccardi8Antonio Gasbarrini9Maurizio Pompili10Maria Assunta Zocco11Internal Medicine, Gastroenterology and Hepatology, Fondazione Policlinico Agostino Gemelli IRCCSInternal Medicine, Gastroenterology and Hepatology, Fondazione Policlinico Agostino Gemelli IRCCSInternal Medicine, Fondazione Policlinico Agostino Gemelli IRCCSInternal Medicine, Gastroenterology and Hepatology, Fondazione Policlinico Agostino Gemelli IRCCSInternal Medicine, Gastroenterology and Hepatology, Fondazione Policlinico Agostino Gemelli IRCCSInternal Medicine, Gastroenterology and Hepatology, Fondazione Policlinico Agostino Gemelli IRCCSInternal Medicine, Gastroenterology and Hepatology, Fondazione Policlinico Agostino Gemelli IRCCSInternal Medicine, Fondazione Policlinico Agostino Gemelli IRCCSInternal Medicine, Gastroenterology and Hepatology, Fondazione Policlinico Agostino Gemelli IRCCSInternal Medicine, Gastroenterology and Hepatology, Fondazione Policlinico Agostino Gemelli IRCCSInternal Medicine, Gastroenterology and Hepatology, Fondazione Policlinico Agostino Gemelli IRCCSInternal Medicine, Gastroenterology and Hepatology, Fondazione Policlinico Agostino Gemelli IRCCSAbstract Minimal hepatic encephalopathy (MHE) is a subclinical complication of liver cirrhosis with a relevant social impact. Thus, there is urgent need to implement easy to use diagnostic tools for the early identification of affected patients. The aim of this study was to investigate cerebral blood flow, systemic hemodynamics as well as endothelial function of cirrhotic patients with MHE, and to verify their change after treatment with rifaximin. Fifty cirrhotic patients with or without MHE and an equal number of healthy controls underwent transcranial Doppler ultrasound (TCD), abdominal Doppler ultrasound (US), and measurement of flow mediated dilation (FMD). In cirrhotic patients diagnosed with MHE receiving rifaximin, the tests were repeated at the end of treatment. Middle (MCA) and posterior (PCA) cerebral artery resistive (RI) and pulsatility (PI) indices were higher in cirrhotic patients than controls, as well as renal and splenic artery RI. Conversely, FMD was reduced. MCA-RI and PI were even higher in cirrhotic patients with MHE compared to those without; a MCA-RI cut-off of 0.65 showed an accuracy of 74% in discriminating the presence of MHE, with 65% sensitivity and 76% specificity. Rifaximin treatment showed no efficacy in the modulation of cerebral vascular flow. In conclusion, cirrhotic patients with MHE have significantly increased cerebral vascular resistances that are not improved by rifaximin treatment. MCA-RI measurement has a good accuracy for the diagnosis of MHE and can be useful for the early identification of this harmful complication of liver cirrhosis.https://doi.org/10.1038/s41598-019-51867-6 |
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DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Francesca Romana Ponziani Barbara Funaro Andrea Lupascu Maria Elena Ainora Matteo Garcovich Gianluigi Caracciolo Alessandro Quadarella Antonio Nesci Laura Riccardi Antonio Gasbarrini Maurizio Pompili Maria Assunta Zocco |
spellingShingle |
Francesca Romana Ponziani Barbara Funaro Andrea Lupascu Maria Elena Ainora Matteo Garcovich Gianluigi Caracciolo Alessandro Quadarella Antonio Nesci Laura Riccardi Antonio Gasbarrini Maurizio Pompili Maria Assunta Zocco Minimal Hepatic Encephalopathy is Associated with Increased Cerebral Vascular Resistance. A Transcranial Doppler Ultrasound Study Scientific Reports |
author_facet |
Francesca Romana Ponziani Barbara Funaro Andrea Lupascu Maria Elena Ainora Matteo Garcovich Gianluigi Caracciolo Alessandro Quadarella Antonio Nesci Laura Riccardi Antonio Gasbarrini Maurizio Pompili Maria Assunta Zocco |
author_sort |
Francesca Romana Ponziani |
title |
Minimal Hepatic Encephalopathy is Associated with Increased Cerebral Vascular Resistance. A Transcranial Doppler Ultrasound Study |
title_short |
Minimal Hepatic Encephalopathy is Associated with Increased Cerebral Vascular Resistance. A Transcranial Doppler Ultrasound Study |
title_full |
Minimal Hepatic Encephalopathy is Associated with Increased Cerebral Vascular Resistance. A Transcranial Doppler Ultrasound Study |
title_fullStr |
Minimal Hepatic Encephalopathy is Associated with Increased Cerebral Vascular Resistance. A Transcranial Doppler Ultrasound Study |
title_full_unstemmed |
Minimal Hepatic Encephalopathy is Associated with Increased Cerebral Vascular Resistance. A Transcranial Doppler Ultrasound Study |
title_sort |
minimal hepatic encephalopathy is associated with increased cerebral vascular resistance. a transcranial doppler ultrasound study |
publisher |
Nature Publishing Group |
series |
Scientific Reports |
issn |
2045-2322 |
publishDate |
2019-10-01 |
description |
Abstract Minimal hepatic encephalopathy (MHE) is a subclinical complication of liver cirrhosis with a relevant social impact. Thus, there is urgent need to implement easy to use diagnostic tools for the early identification of affected patients. The aim of this study was to investigate cerebral blood flow, systemic hemodynamics as well as endothelial function of cirrhotic patients with MHE, and to verify their change after treatment with rifaximin. Fifty cirrhotic patients with or without MHE and an equal number of healthy controls underwent transcranial Doppler ultrasound (TCD), abdominal Doppler ultrasound (US), and measurement of flow mediated dilation (FMD). In cirrhotic patients diagnosed with MHE receiving rifaximin, the tests were repeated at the end of treatment. Middle (MCA) and posterior (PCA) cerebral artery resistive (RI) and pulsatility (PI) indices were higher in cirrhotic patients than controls, as well as renal and splenic artery RI. Conversely, FMD was reduced. MCA-RI and PI were even higher in cirrhotic patients with MHE compared to those without; a MCA-RI cut-off of 0.65 showed an accuracy of 74% in discriminating the presence of MHE, with 65% sensitivity and 76% specificity. Rifaximin treatment showed no efficacy in the modulation of cerebral vascular flow. In conclusion, cirrhotic patients with MHE have significantly increased cerebral vascular resistances that are not improved by rifaximin treatment. MCA-RI measurement has a good accuracy for the diagnosis of MHE and can be useful for the early identification of this harmful complication of liver cirrhosis. |
url |
https://doi.org/10.1038/s41598-019-51867-6 |
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