Liver volume is lower and associates with resting and dynamic blood pressure variability in CFS

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Liver volume is lower and associates with resting and dynamic blood pressure variability in chronic fatigue syndrome
Pawel Zalewski, Andreas Finkelmeyer, James Frith, Laura Maclachlan, Andrew Blamire & Julia L. Newton
Received 23 Mar 2018, Accepted 11 Jun 2018, Published online: 18 Jun 2018
ABSTRACT
Background: Chronic fatigue syndrome (CFS) in many cases is characterised by abnormal autonomic function and lower blood pressure (BP). In animals the liver is a capacitance vessel for BP homeostasis. We developed a novel liver magnetic resonance (MR) imaging technique to compare liver volume in CFS to controls, and to explore its role in cardiovascular physiology.

Methods: Liver MR (single breath-hold, enhanced T1-weighted, high-resolution isotropic volume excitation 3-Tesla Achieva, NL) determined liver volume. Red cell and plasma volume were also measured. A 10 min resting cardiac autonomic assessment using beat-to-beat measurement (Taskforce; CNSystems) was followed by assessment of hemodynamic response to standing to determine blood pressure drop and return to baseline.

Results: Forty-four CFS patients (age = 45.5, 34f/10 m, Fukuda criteria) and 10 age, activity and sex matched controls (age = 49.4, 7f/3 m) participated. Adjusted for body size, CFS patients had significantly reduced liver volumes (775 (101) ml/m2 v 846 (96) ml/m2; p = 0.02). At rest, liver volume was unrelated to symptom severity, heart rate, BP or heart rate variability. Both increased systolic and diastolic low frequency (LF) BP variability (predominantly sympathetic) were associated with lower liver volumes. On standing, liver volume was unrelated to BP drop but was associated with successful BP return-to-baseline. Red cell and plasma volume were associated positively with liver volume. Multivariate analysis confirmed return-to-baseline BP on standing which was independently associated with liver volume.

Conclusion: Liver volumes were smaller in CFS compared to controls. The relationship between return-to-baseline BP after standing and liver volume suggests, as in animals, that the liver is involved in maintenance of BP.

Abbreviations: ACI: Accelerated cardiac index; BPV: Blood pressure variability; BRS: Baroreflex sensitivity; CFS: chronic fatigue syndrome; Chr: Chromium; CI: cardiac index; FIS: Fatigue impact scale; HF: High frequency; HRV: Heart rate variability; LF: Low frequency; MR: magnetic resonance; NU: normalised units; SD: Standardised deviation; PSD: power spectral density; SI: Stroke index; TPRI: Total peripheral resistance index

https://www.tandfonline.com/doi/abs/10.1080/21641846.2018.1488525?journalCode=rftg20
 

mariovitali

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OTOH, this is not funny. Despite evidence of Liver fibrosis in some ME/CFS patients, no thorough testing to greater scale yet.

Is it really just #MillionsMissing?


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Assessment of liver volume variation to evaluate liver function.
Tong C1, Xu X, Liu C, Zhang T, Qu K.
Author information

Abstract
In order to assess the value of liver volumetry in cirrhosis and acute liver failure (ALF) patients, we explored the correlation between hepatic volume and severity of the hepatic diseases. The clinical data of 48 cirrhosis patients with 60 normal controls and 39 ALF patients were collected. Computed tomography-derived liver volume (CTLV) and body surface area (BSA) of normal controls were calculated to get a regression formula for standard liver volume (SLV) and BSA. Then CTLV and SLV of all patients were calculated and grouped by Child-Turcotte-Pugh classification for cirrhosis patients and assigned according to prognosis of ALF patients for further comparison. It turned out that the mean liver volume of the control group was 1,058 ± 337 cm(3). SLV was correlated with BSA according to the regression formula. The hepatic volume of cirrhosis patients in Child A, B level was not reduced, but in Child C level it was significantly reduced with the lowest liver volume index (CTLV/SLV). Likewise, in the death group of ALF patients, the volume index was significantly lower than that of the survival group. Based on volumetric study, we proposed an ROC (receiver operating characteristic) analysis to predict the prognosis of ALF patients that CTLV/SLV < 83.9% indicates a poor prognosis. In conclusion, the CTLV/SLV ratio, which reflects liver volume variations, correlates well with the liver function and progression of cirrhosis and ALF. It is also a very useful marker for predicting the prognosis of ALF.
 

pamojja

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The implications of a smaller liver volume in CFS are unclear. Our finding of increased
sympathetic drive could suggest that a smaller liver volume arises because of increased
resistance in the intrahepatic portal vein tract. There is a large volume of blood passing
through the hepatic portal system and the liver allows Kupffer cells to clean large
volumes of blood very quickly. A smaller liver volume may have implications for a wide
range of liver functions. The human liver plays a key role in digestion and metabolism
including energy metabolism, detoxification, storage of vitamins and minerals – such as
vitamins A, D, E, K, and B12, and the minerals iron and copper.

It is possible that disruption of these physiological functions even to a small degree
could have functional consequences which might be secondary to CFS or alternatively
any subclinical effects of reduced liver function might account for some of the symptoms
experienced by this group. It is not possible in this observational study to determine
whether the lower liver volume seen in the CFS group is a primary or secondary phenom
enon. Our finding of thoracic fluid content as an independent predictor of liver volume
suggests it could be secondary, however more work needs to be done to explore this
relationship further.

Our study may highlight potential abnormalities for further work in CFS which might
point towards its underlying pathophysiology. Our study has shown that there are poten
tial hemodynamic consequences of the reduced liver volume seen in the CFS group which
might explain in part the lower blood pressure and high prevalence of autonomic dysfunc
tion often seen in CFS [1–8]. Liver volumes in animal models have shown associations
between blood pressure and liver volume suggesting that the liver and spleen are
major capacitance vessels for blood pressure homeostasis in animals [36–40]. Our study
suggests that the same may be true in humans using CFS as an exemplar group with a
high prevalence of autonomic dysfunction. The relationships seen between systolic and
diastolic blood pressure variability particularly low frequency, considered to be a marker
predominantly of sympathetic autonomic activity, would suggest that the liver is acting
as a capacitance vessel for blood pressure homeostasis. Our study also suggests that
the independent relationship between blood pressure return to baseline after standing
and liver volume could point towards the liver being intimately involved in maintenance
of blood pressure, warranting further investigation.

Our study did not suggest a relationship between symptom severity and liver volume in
CFS. This is not surprising, given that the liver has a huge reserve and enormous capacity to
compensate for subtle deficiencies. It is likely that any consequences of a relatively small
liver would be subclinical.
 

Wally

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I wonder what the average cost would be for performing tomography testing (x-ray or ultrasound) on the liver? I know I have had ultrasound testing of my liver in the past. Very easy, quick procedure - the findings were non alcoholic fatty liver disease. These tests were run before I was diagnosed with this illness when an endocrinologist was searching for answers to my extreme levels of fatigue etc... I will see if I can find those test results and also see if the imagery from this test is still available for review.

Not sure what information could be gleaned from those prior tests that might be relevant to the information that they found in this study. But it could be interesting to see how many patients diagnosed with ME/CFS, under newer criteria such as the “Canadian Consensus”, may have had liver tomography testing that did or did not reveal an abnormality with the structure of the liver.

Edit - Does anyone know if tomography testing of the liver is one of the tests included in the NIH ME/CFS Intramural Study?
 
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mariovitali

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Unfortunately, the gold standard to rule out any kind of Liver issues is biopsy from multiple sites.

This is not an easy task and it may also have complications. In my understanding, the second best method to rule out Liver involvement is to perform a test called Liver Elastography aka Fibroscan.
 
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Unfortunately, the gold standard to rule out any kind of Liver issues is biopsy from multiple sites.

This is not an easy task and it may also have complications. In my understanding, the second best method to rule out Liver involvement is to perform a test called Liver Elastography aka Fibroscan.
@mariovitali what type of complications can occur from having a liver biopsy? I imagine this would be quite a painful procedure, but curious to know if it’s the type that could potentially have lasting negative impacts on sensitive patients...
 

mariovitali

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@mariovitali what type of complications can occur from having a liver biopsy? I imagine this would be quite a painful procedure, but curious to know if it’s the type that could potentially have lasting negative impacts on sensitive patients...
If anyone is thinking of doing this procedure, it would be better to discuss with a hepatologist to have a detailed view of pros and cons.