Z Gastroenterol 2014; 52 - P66
DOI: 10.1055/s-0034-1376050

Cardiopulmonary response to exercise in patients with portal hypertension and early stages of liver cirrhosis

P Douschan 1, 2, G Kovacs 1, 2, V Stadlbauer-Köllner 3, W Spindelböck 3, E Krones 3, F Durchschein 3, G Zollner 3, F Rainer 3, V Foris 1, 2, M Wagner 3, P Fickert 3, H Olschewski 1, 2, R Stauber 3
  • 1Universitätsklinik für Innere Medizin, Abteilung für Pulmonologie, Graz, Austria
  • 2Ludwig Boltzmann Institut für Lungengefäßforschung, Graz, Austria
  • 3Universitätsklinik für Innere Medizin, Abteilung für Gastroenterologie und Hepatologie, Graz, Austria

Background: Portal hypertension (PHT) and cirrhosis may affect the cardiopulmonary system and may be associated with decreased exercise capacity. However this has not been systematically addressed in clinical studies in patients with compensated liver cirrhosis.

Aims: We aimed to investigate the cardiovascular response to exercise in patients with PHT and well-preserved liver function.

Methods: Patients with PHT from our outpatient liver clinic without severe cardiopulmonary co-morbidities were invited to take part in a cardiopulmonary screening program including pulmonary function testing, blood gas analysis, echocardiography and symptom limited cardiopulmonary exercise testing.

Results: Sixty consecutive patients were included. In 58/60 patients cirrhosis was the underlying liver disease (Child-Pugh A: 62%, Child-Pugh B: 36%, Child-Pugh C: 2%). Two patients suffered from non-cirrhotic portal hypertension. 46/60 patients had a decreased exercise capacity (peak oxygen uptake [peak VO2] ≤85% predicted), showing a mean peak VO2 of 65 ± 25%. Subgroup analysis revealed that Child-Pugh B patients had lower peak VO2 compared to Child-Pugh A patients (56 ± 20% vs. 71 ± 25%, p = 0.02). In addition, Child-Pugh B patients had a lower diffusion capacity (DLCOcVA: 82 ± 13% vs. 92 ± 20%, p = 0.04) and tended to have higher minimal ventilatory equivalents for CO2 (min EqCO2: 31.9 ± 4.7% vs. 29.0 ± 6.6%, p = 0.07), suggesting an altered cardiopulmonary response during exercise.

Conclusion: Impairment of exercise capacity and alteration of gas exchange parameters are common findings in patients suffering from early stage liver disease and are related to the severity of the underlying disease.