Document Detail


Non-selective β-blockers improve the correlation of liver stiffness and portal pressure in advanced cirrhosis.
MedLine Citation:
PMID:  22170417     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Liver stiffness (LS) correlates with portal pressure (hepatic venous pressure gradient, HVPG). However, the dynamic components of portal hypertension (PHT) in advanced cirrhosis may not be adequately assessed by TE. The influence of treatment with non-selective β-blockers (NSBB) on the correlation of HVPG and LS has not been investigated.
METHODS: One hundred and twenty-two patients with esophageal varices were included. LS, hemodynamic parameters, and HVPG were recorded at baseline (BL) and after 6 weeks of treatment with NSBB (FU). The correlation of LS and HVPG was compared to control patients with HVPG ≤ 12 mmHg.
RESULTS: Patients with higher Child-Pugh stages (A:88/B:25/C:9) had higher levels of liver stiffness (47.4 ± 16.5 vs. 70.3 ± 7.9 vs. 73.7 ± 2.1 kPa) and HVPG (21 ± 5 vs. 26 ± 5 vs. 26 ± 4 mmHg). The correlation of LS and HVPG was stronger in controls with HVPG ≤ 12 mmHg (R = 0.951; P < 0.0001) than in patients with HVPG > 12 mmHg (R = 0.538; P = 0.0004). The association of HVPG with LS became stronger under treatment with NSBB, which finally restored the linear correlation of HVPG and LS (R = 0.930; P < 0.0001). Forty-three percent (53/122) of patients were hemodynamic responders to NSBB. The improvement in the correlation of LS and HVPG under NSBB was mainly noted in hemodynamic responders (R = 0.864), but not in nonresponders (R = 0.535), whereas changes in LS, heart rate, and MAP were similar in responders and nonresponders.
CONCLUSIONS: Targeting the hyperdynamic circulation and the increased splanchnic blood inflow by treatment with NSBB unmasks the linear (mechanical) correlation of HVPG and LS in patients with HVPG > 12 mmHg. Measurement of LS by TE is not a feasible method to assess the dynamic components of PHT.
Authors:
T Reiberger; A Ferlitsch; B A Payer; M Pinter; M Homoncik; M Peck-Radosavljevic;
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Publication Detail:
Type:  Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't     Date:  2011-12-15
Journal Detail:
Title:  Journal of gastroenterology     Volume:  47     ISSN:  1435-5922     ISO Abbreviation:  J. Gastroenterol.     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-05-28     Completed Date:  2012-09-13     Revised Date:  2013-05-28    
Medline Journal Info:
Nlm Unique ID:  9430794     Medline TA:  J Gastroenterol     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  561-8     Citation Subset:  IM    
Affiliation:
Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University Vienna, Waehringer Guertel 18-20, Vienna, Austria.
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MeSH Terms
Descriptor/Qualifier:
Adrenergic beta-Antagonists / pharmacology*,  therapeutic use
Adult
Carbazoles / pharmacology,  therapeutic use
Elasticity / drug effects
Elasticity Imaging Techniques / methods
Esophageal and Gastric Varices / complications,  physiopathology
Feasibility Studies
Female
Gastrointestinal Hemorrhage / etiology,  physiopathology,  prevention & control
Hemodynamics / drug effects,  physiology
Humans
Hypertension, Portal / etiology,  physiopathology,  ultrasonography
Liver / physiopathology*
Liver Cirrhosis / complications,  drug therapy*,  physiopathology,  ultrasonography
Male
Middle Aged
Portal Pressure / drug effects*,  physiology
Propanolamines / pharmacology,  therapeutic use
Propranolol / pharmacology,  therapeutic use
Prospective Studies
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Carbazoles; 0/Propanolamines; 0K47UL67F2/carvedilol; 525-66-6/Propranolol

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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