Effect of beta-blockers on multiple haemodynamics in cirrhosis: A cross-over study by MR-imaging and hepatic vein catheterization

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningfagfællebedømt

Background: Non-selective beta-blockers (NSBB) are widely used in the treatment of patients with cirrhosis. Only about 50% respond with a sufficient reduction in their hepatic venous pressure gradient (HVPG) and NSBB may induce detrimental cardiac and renal effects in the presence of severe decompensation. We aimed to assess the effects of NSBB on haemodynamics using magnetic resonance imaging (MRI) and to assess if these haemodynamic changes were related to the disease severity and HVPG response. Method: A prospective cross-over study of 39 patients with cirrhosis. Patients underwent hepatic vein catheterization and MRI with assessments of HVPG, cardiac function, systemic and splanchnic haemodynamics before and after propranolol infusion. Results: Propranolol induced significant decreases in cardiac output (−12%) and blood flow of all vascular compartments, with the largest reductions seen in the azygos venous (−28%), portal venous (−21%), splenic (−19%) and superior mesenteric artery (−16%) blood flow. Renal artery blood flow fell by −5% in the total cohort, with a more pronounced reduction in patients without ascites than in those with ascites (−8% vs. −3%, p =.01). Twenty-four patients were NSBB responders. Their changes in HVPG after NSBB were not significantly associated with other haemodynamic changes. Conclusion: The changes in cardiac, systemic and splanchnic haemodynamics did not differ between NSBB responders and non-responders. The effects of acute NSBB blockade on renal flow seem to depend on the severity of the hyperdynamic state, with the largest reduction in renal blood flow in compensated patients compared to decompensated patients with cirrhosis. However, future studies are needed to assess the effects of NSBB on haemodynamics and renal blood flow in patients with diuretic-resistant ascites.

OriginalsprogEngelsk
TidsskriftLiver International
Vol/bind43
Udgave nummer10
Sider (fra-til)2245-2255
Antal sider11
ISSN1478-3223
DOI
StatusUdgivet - 2023

Bibliografisk note

Funding Information:
We sincerely thank the staff at the Centre for Functional and Diagnostic Imaging and Research, and the Gastro Unit at Hvidovre University Hospital, for their efforts. We would especially thank the excellent MR technicians at these centres. This project has received financial support from the Amager Hvidovre University Hospital Research Foundation and Ferring Pharmaceuticals A/S.

Funding Information:
The study was supported by an independent research grant from Ferring Pharmaceuticals A/S.

Publisher Copyright:
© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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