Noninvasive measurement of femoral blood flow and portal pressure response to propranolol in patients with cirrhosis

✍ Scribed by Angelo Luca; Juan Carlos Garí-Pagán; Faust Feu; Juan Carlos Lopez-Talavera; Mercedes Fernández; Concepció Bru; Jaime Bosch; Juan Rodés

• Publisher: John Wiley and Sons
• Year: 1995
• Tongue: English
• Weight: 721 KB
• Volume: 21
• Category: Article
• ISSN: 0270-9139
• DOI: 10.1002/hep.1840210115

✦ Synopsis

This study investigated the correlation between changes in hepatic and systemic hemodynamics and femoral blood flow (FBF), measured by dual-beam pulsed wave Doppler, in 58 portal hypertensive patients receiving propranolol(O.15 mg/Kg intravenously; n = 44) or placebo (n = 14) under double-blind conditions. Placebo administration had no effects. Propranolol caused significant reductions (P < .0001) in hepatic venous pressure gradient (HVPG from 19.1 I 4.1 to 16.2 5 4.2 mm Hg), azygos blood flow (from 563 5 204 to 387 I 176 mJJ min), cardiac index (CI; from 4.4 5 1.0 to 3.3 5 0.8 Urn2/ min), and FBF (from 237 5 79 to 176 5 58 mIJm'/min). In 17 patients HVPG decreased below 12 mm Hg and/or more than 20% of the baseline value (good response; mean change, -26 I 8%); in the remaining 27 patients (poor response) the mean change in HVPG was less: -9 t 6%. Patients with a good response had bled less often from varices, had significantly higher FBF (272 73 vs. 215 5 76 mLlm2/min) and lower baseline HVPG (16.8 t 3.9 vs. 20.6 2 3.6 mm Hg) than those with poor response in HVPG. The good response was also associated with greater decreases in FBF (-33 ? 12 vs. -19 i-13% in poor responders), CI (-30 5 9 vs. -19 I 12%), and heart rate (-19 5 5 vs. -16 2 6%). A decrease in FBF of >2W0 predicted a good response in 16 of 28 patients (positive predictive value, 57%). A negative test (decrease in femoral blood flow of <20%) predicted a lack of response in HVPG in 15 of 16 patients (negative predictive value, 94%). This study suggests that the noninvasive measurements of FBF allow the identification of patients with a poor response of HVPG to propranolol. However, measurements of HVPG would still be needed for patients Abbreviations: HVPG, hepatic venous pressure gradient; CI, cardiac index; M, mean; SD, standard deviation; FHVP, free hepatic venous pressure; WHVP, wedged hepatic venous pressure; IV, intravenous.