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Increased splanchnic arterial vascular resistance in oldest old patients

Possible relevance for postprandial hypotension

Erhöhter Gefäßwiderstand der Baucharterie bei sehr alten Patienten: Mögliche Bedeutung für niedrigen Blutdruck nach den Mahlzeiten

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Abstract

Objectives

The aim of this study was to evaluate possible age-related changes in mesenteric artery and portal venous blood flow dynamics in relation to systemic haemodynamics in order to delineate putative haemodynamic changes relevant for postprandial hypotension in the elderly. Studies were performed over a wide age-range and for the first time in over 85-year-old patients.

Design

Superior mesenteric artery (SMA) parameters (diameter, peak systolic velocity, enddiastolic velocity, pulsatility index, volume flow) and portal vein (PV) parameters (diameter, portal vein velocity, volume flow) were measured by duplex ultrasound (General Electrics, Vivid 3) in 98 fasting subjects aged from 21 to 96 years. Systemic vascular parameters such as blood pressure, heart rate and cardiac output (echocardiography) were also determined. Excluded were patients with severe heart failure, liver cirrhosis, sepsis and those with mesenteric artery stenosis.

Results

Pulsatility index (PI) was positively correlated with age (r=0.33, p=0.015). In patients over 85 years, PI was significantly increased (p=0.002) as compared to younger controls. Cardiac output was negatively correlated with age (r=–0.247, p=0.005). The other haemodynamic parameters did not show age-dependent alterations.

Conclusion

The increase of PI in the SMA in patients over 85 years represents an increase of vascular resistance in the splanchnic area, because PI is sensitive to resistance changes of small arterial vessels. The pulsatility index in the splanchnic area seems to rise steeply in oldest old patients, probably as an attempt to compensate diminutions in cardiac output seen in this age group. These findings indicate that the splanchnic vascular bed is already used in the fasting state to guarantee systemic haemodynamics. Vasodilatation of this vascular bed as physiologically seen postprandially may therefore easily induce postprandial hypotension in the oldest old.

Zusammenfassung

Einführung

Ziel der vorliegenden Arbeit war die Untersuchung von möglichen Alters-assoziierten Blutflussveränderungen im splanchnischen vaskulären Bett – A. mesenterica superior (SMA) und Portalvene (PV) –, die Ursache für die postprandiale Hypotonie sein könnten. Untersucht wurden hierzu ältere und zum ersten Mal Patienten über 85 Jahre.

Methodik

SMA-Parameter (Durchmesser, peak systolic velocity, enddiastolic velocity, Pulsatilitätsindex, Volumenfluss) und PV-Parameter (Durchmesser, portal vein velocity, Volumenfluss) wurden mittels Doppler-Ultraschall (General Electrics, Vivid 3) in 98 Menschen im Alter von 21–96 Jahren im Nüchternzustand untersucht. Als systemische hämodynamische Parameter wurden der Blutdruck, die Herzfrequenz und das Herzzeitvolumen (CO) (Echokardiographie) gemessen. Ausgeschlossen wurden Patienten mit schwerer Herzinsuffizienz, Leberzirrhose, Sepsis sowie Stenose der A. mesenterica superior.

Resultate

Der Pulsatilitätsindex (PI) zeigte sich positiv mit dem Alter korreliert (r=0,33; p=0,015). In über 85-jährigen Patienten war der PI signifikant höher als bei Jüngeren (p=0,002). Dagegen war der CO negativ mit dem Alter korreliert (r=–0,247; p=0,005). Die anderen gemessenen hämodynamischen Parameter zeigten keine signifikante Altersassoziation.

Zusammenfassung und Schlussfolgerung

Der signifikante Anstieg des PI bei über 85-jährigen Patienten weist auf eine erhöhte vaskuläre splanchnische Resistenz hin, da der PI sensitiv den vaskulären Tonus auf arteriolärer Ebene misst. Der PI steigt bei Hochbetagten steil an, vermutlich als Zeichen hierfür, dass damit versucht wird, den verminderten CO zu kompensieren. Somit scheint das große Blutreservoir im Splanchnikusgebiet schon im Nüchternzustand zur Garantierung der systemischen Hämodynamik mobilisiert zu werden. Vasodilatation auf dieser Ebene – wie physiologischerweise postprandial beobachtet – prädisponiert diese Menschen somit zu einer postprandialen Hypotonie.

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Abbreviations

SMA:

superior mesenteric artery

SMA_PI:

SMA pulsatility index

SMA_RI:

SMA resistance index

SMA_PSV:

SMA peak systolic velocity in cm/s

SMA_EDV:

SMA enddiastolic velocity in cm/s

SMA_VF:

SMA volume flow in l/min

SMA_VFCO:

SMA volume flow in % of CO

SMA_dia:

SMA diameter in mm

PV_V:

mean portal velocity in cm/s

PV_F:

portal venous blood flow in ml/min

PV_F-CO:

portal venous blood flow in % of Co

Dia 1 and Dia 2:

the diameters of the cross sectional area of the vessel in mm

RR syst:

systolic blood pressure in mmHg

RR diast:

diastolic blood pressure in mmHg

PP:

pulse pressure in mmHg

MAP:

mean arterial pressure in mmHg

Temp:

body temperature in °C

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Authors and Affiliations

  1. Klinik Kh II-2, Klinikum Nürnberg, Prof. Ernst-Nathan-Straße 1, 90419, Nürnberg, Germany

    S. Wicklein MD

  2. Chair Internal Medicine – Geriatrics, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen-Nürnberg, Germany

    S. Wicklein MD, W. Mühlberg, B. Richter & C. C. Sieber

  3. Clinic of Medicine II, Klinikum Nürnberg, Nürnberg, Germany

    S. Wicklein MD, W. Mühlberg, B. Richter & C. C. Sieber

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  2. W. Mühlberg
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Correspondence to S. Wicklein MD.

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Wicklein, S., Mühlberg, W., Richter, B. et al. Increased splanchnic arterial vascular resistance in oldest old patients. Z Gerontol Geriatr 40, 37–42 (2007). https://doi.org/10.1007/s00391-007-0431-9

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  • DOI: https://doi.org/10.1007/s00391-007-0431-9

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