Decompensation in Advanced Nonalcoholic Fatty Liver Disease May Occur at Lower Hepatic Venous Pressure Gradient Levels Than in Patients With Viral Disease

Bassegoda, Octavi; Olivas, Pol; Turco, Laura; Mandorfer, Mattias; Serra-Burriel, Miquel; Téllez, Luís; Kwanten, Wilhelmus J.; Laroyenne, Alexia; Farcau, Oana; Alvarado, Edilmar; Moga, Lucile; Vuille‐Lessard, Élise; Fortea, José Ignacio; Ibáñez, Luis; Tosetti, Giulia; Vanwolleghem, Thomas; Larrue, Hélène; Burgos‐Santamaría, Diego; Ştefănescu, Horia; Paternostro, Rafael; Cippitelli, Annalisa; Lens, Sabela; Augustín, Salvador; Llop, Elba; Laleman, Wim; Trebicka, Jonel; Chang, Johannes; Masnou, Helena; Zipprich, Alexander; Miceli, Francesca; Semmler, Georg; Forns, Xavier; Primignani, Massimo; Bañares, Rafael; Puente, Ángela; Berzigotti, Annalisa; Rautou, P.-E.; Villanueva, Càndid; Ginès, Pere; García‐Pagán, Juan Carlos; Procopeţ, Bogdan; Bureau, C.; Albillos, Agustı́n; Francque, Sven; Reiberger, Thomas; Schepis, Filippo; Graupera, Isabel; Hernández‐Gea, Virginia

doi:10.1016/j.cgh.2021.10.023

Cited by 56 publications

(35 citation statements)

References 25 publications

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“…Finally, with the emerging incidence of non‐alcoholic steatohepatitis cirrhosis, we will probably face new models of portal hypertension with some haemodynamic peculiarities 95,96 . Moreover, liver disease and cardiovascular comorbidities (diabetes mellitus, obesity, arteriosclerotic coronary disease and essential hypertension) usually coexist and can modify cardiac and kidney function.…”

Section: Non‐selective Beta‐blockers In Cirrhosis and Ascites: Curren...mentioning

confidence: 99%

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Non‐selective beta‐blockers in patients with ascites: The complex interplay among the liver, kidney and heart

Téllez

Albillos

2022

Liver International

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Non‐selective beta‐blockers (NSBBs) are the cornerstone of the primary and secondary prophylaxis of variceal bleeding in cirrhotic patients. They additionally prevent ascites development and death in compensated patients with clinically significant portal hypertension. After ascites onset, NSBBs remain beneficial for preventing further decompensations. However, as the cirrhosis progresses, the inflammation increases, systemic vasodilatation worsens, ascites turns refractory and cardiodynamic equilibrium becomes extremely fragile. In this scenario, NSBBs can critically impair the cardiac reserve and facilitate a haemodynamic breakdown, imperilling renal perfusion. Consequently, NSBB treatment should be carefully monitored or even avoided in such patients, and other options for portal hypertension management should be considered. In the present review, we explore the effects of NSBBs in patients with ascites and discuss the complex interplay among their hepatic, systemic and renal haemodynamic effects in this scenario.

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Section: Non‐selective Beta‐blockers In Cirrhosis and Ascites: Curren...mentioning

confidence: 99%

“…94 Finally, with the emerging incidence of non-alcoholic steatohepatitis cirrhosis, we will probably face new models of portal hypertension with some haemodynamic peculiarities. 95,96 Moreover, liver…”

Section: Non-selec Tive Be Ta-blockers In Cirrhosis and A Scite S: Cu...mentioning

confidence: 99%

Non‐selective beta‐blockers in patients with ascites: The complex interplay among the liver, kidney and heart

Téllez

Albillos

2022

Liver International

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“…It has been recently demonstrated that, in decompensated patients with NASH-related cirrhosis, HVPG may underestimate portal pressure. 13,14 The real impact of different thresholds of In patients without ascites: variceal bleeding (first in primary prophylaxis studies, recurrent in secondary prophylaxis studies), ascites, or encephalopathy; in patients with ascites: variceal bleeding (first in primary prophylaxis studies, recurrent in secondary prophylaxis studies) or refractory ascites, spontaneous bacterial peritonitis, hepatorenal syndrome, or encephalopathy.…”

Section: Limitations and Future Are As Of Studymentioning

confidence: 99%

Portal pressure reductions induced by nonselective beta‐blockers improve outcomes and decrease mortality in patients with cirrhosis with and without ascites

Turco

García–Tsao

2022

Clinical Liver Disease

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“…9,14 Furthermore, liver decompensation may develop at lower HVPG in patients with NAFLD than in those with viral liver disease, underscoring differences in disease pathophysiology. 15 Therefore, this gold standard invasive method might not be accurate for assessing PHT in people with NAFLD. Thus, there are currently a large number of questions and challenges that arise in the detection of PHT in this patient population.…”

Section: Introductionmentioning

confidence: 99%

“…However, recent observations suggest that HVPG may underestimate the true PVP in patients with NAFLD 9,14 . Furthermore, liver decompensation may develop at lower HVPG in patients with NAFLD than in those with viral liver disease, underscoring differences in disease pathophysiology 15 . Therefore, this gold standard invasive method might not be accurate for assessing PHT in people with NAFLD.…”

Section: Introductionmentioning

confidence: 99%

Portal hypertension in nonalcoholic fatty liver disease: Challenges and perspectives

Miao

Targher

Byrne

et al. 2022

Portal Hypertension & Cirrhosis

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Nonalcoholic fatty liver disease (NAFLD) has become the most common chronic liver disease worldwide. NAFLD‐related cirrhosis is often complicated by portal hypertension (PHT). Recent evidence showed that portal venous pressure (PVP) starts to rise in the early stages of NAFLD, even in absence of advanced fibrosis or cirrhosis. However, the precise pathological mechanisms of this process are still poorly understood. Lipid accumulation, hepatocellular ballooning, sinusoidal endothelial cell dysfunction, capillarization, microthrombosis, increased angiogenesis, and pericellular fibrosis may all be involved in the early development of increased PVP in NAFLD. Direct measurement of PHT is invasive and impractical in noncirrhotic NAFLD individuals and may also underestimate its severity. Thus, the development and validation of noninvasive and more accurate measurements, including new serum biomarkers, scoring models, and imaging techniques (such as ultrasonography, elastography, and magnetic resonance imaging), are urgently needed. Owing to the increasing morbidity, challenges in the prevention and management of PHT in NAFLD are unprecedented. This review article aims to briefly discuss these challenges and summarizes the mechanisms, diagnosis, and emerging therapies for PHT in people with NAFLD.

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Decompensation in Advanced Nonalcoholic Fatty Liver Disease May Occur at Lower Hepatic Venous Pressure Gradient Levels Than in Patients With Viral Disease

Cited by 56 publications

References 25 publications

Non‐selective beta‐blockers in patients with ascites: The complex interplay among the liver, kidney and heart

Non‐selective beta‐blockers in patients with ascites: The complex interplay among the liver, kidney and heart

Portal pressure reductions induced by nonselective beta‐blockers improve outcomes and decrease mortality in patients with cirrhosis with and without ascites

Portal hypertension in nonalcoholic fatty liver disease: Challenges and perspectives

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