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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Autores principales:	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
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2019
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/710579cf4e6f416a9623616f20421242
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spelling	oai:doaj.org-article:710579cf4e6f416a9623616f204212422021-12-02T15:08:59ZMinimal Hepatic Encephalopathy is Associated with Increased Cerebral Vascular Resistance. A Transcranial Doppler Ultrasound Study10.1038/s41598-019-51867-62045-2322https://doaj.org/article/710579cf4e6f416a9623616f204212422019-10-01T00:00:00Zhttps://doi.org/10.1038/s41598-019-51867-6https://doaj.org/toc/2045-2322Abstract 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.Francesca Romana PonzianiBarbara FunaroAndrea LupascuMaria Elena AinoraMatteo GarcovichGianluigi CaraccioloAlessandro QuadarellaAntonio NesciLaura RiccardiAntonio GasbarriniMaurizio PompiliMaria Assunta ZoccoNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 9, Iss 1, Pp 1-9 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q 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
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.
format	article
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
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 Portfolio
publishDate	2019
url	https://doaj.org/article/710579cf4e6f416a9623616f20421242
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Minimal Hepatic Encephalopathy is Associated with Increased Cerebral Vascular Resistance. A Transcranial Doppler Ultrasound Study

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