Effects of Propranolol on Azygos Venous Blood Flow and Hepatic and Systemic Hemodynamics in Cirrhosis

Bosch, Jaime; Masti, Ricardo; Kravetz, David; Bruix, Jordi; Gaya, Joan; Rigau, Joaquín; Rodés, Joan

doi:10.1002/hep.1840040617

Cited by 299 publications

(133 citation statements)

References 16 publications

Supporting

Mentioning

122

Contrasting

Unclassified

Order By: Relevance

“…One of them was used to advance a balloon catheter (Medi Tech, Cooper Scientific Corp., Watertown, MA) into the main right hepatic vein for repeated measurements of wedged (occluded) and free hepatic venous pressures. 5 The other was used, in 11 patients, to advance a Swan-Ganz catheter (Edwards Laboratory, Los Angeles, CA) into the pulmonary artery for measurement of cardiopulmonary pressures and, in 12 patients, to advance a 7F coronary sinus continuous thermaldilution catheter (Webster Laboratories, Baldwin Park, CA) into the azygos vein for measurement of azygos blood flow (AzBF). 6 Intravascular pressures were measured using highly sensitive pressure transducers (Hewlett-Packard, model 1280 C, Andover, MA), calibrated before each measurement.…”

Section: Patientsmentioning

confidence: 99%

Effects of propranolol on the hepatic hemodynamic response to physical exercise in patients with cirrhosis

et al. 1998

View full text Add to dashboard Cite

Physical exercise increases portal pressure (hepatic venous pressure gradient [HVPG]) in patients with cirrhosis.It is unknown if this deleterious effect is associated with changes in gastroesophageal collateral blood flow and if these can be prevented by propranolol administration. The aim of this study was to characterize the effects of propranolol on the splanchnic hemodynamic response to exercise in patients with cirrhosis. Twenty-three patients with cirrhosis and portal hypertension had hemodynamic measurements in baseline conditions, and during moderate cycling exercise (40 W) under double-blind propranolol or placebo administration. In patients receiving placebo, HVPG significantly increased during exercise (from 16.7 ؎ 0.9 to 19.0 ؎ 1.0 mm Hg; P F .01), hepatic blood flow (HBF) decreased (-18% ؎ 4%; P F .01), while azygos blood flow (AzBF) was unchanged (4% ؎ 12%; ns). In patients receiving propranolol, portal pressure did not increase during exercise, but decreased from 16.3 ؎ 1.0 to 12.9 ؎ 1.1 mm Hg (P F .01). The lack of increase in HVPG in response to exercise in patients receiving propranolol may be related to a more pronounced decrease in HBF, as compared with patients receiving placebo, and to a blunted increase in cardiac output (CO). Moderate physical exercise adversely influences the hepatic hemodynamics in patients with cirrhosis, causing a significant increase in portal pressure. This is effectively prevented by propranolol pretreatment. (HEPATOL-OGY 1998;28:677-682.)

show abstract

Section: Patientsmentioning

confidence: 99%

Effects of propranolol on the hepatic hemodynamic response to physical exercise in patients with cirrhosis

et al. 1998

View full text Add to dashboard Cite

show abstract

“…duce the risk of variceal bleeding. [5][6][7][8] The purpose of the presTwenty-Four Hour Study. The patients were admitted to hospital ent randomized study was to evaluate the effect of propranotwo days before the study.…”

Section: A Nocturnal Increase In Portal Pressure and Blood Flow Was Dmentioning

confidence: 99%

Daily variation in portal blood flow and the effect of propranolol administration in a randomized study of patients with cirrhosis

et al. 1997

View full text Add to dashboard Cite

A nocturnal increase in portal pressure and blood flow was demonstrated in patients with cirrhosis, suggestingPatients. Fourteen patients with cirrhosis (10 men and 4 women, that these hemodynamic changes may contribute to the mean age 53 { 6 years [mean { SEM]; range, 35-63 years) were triggering of the hemorrhagic episodes observed during included in this study. Diagnosis of the disease was made by liver the night in these patients. It is known that propranolol biopsy in nine patients and was based on clinical and biochemical reduces portal flow, thus reducing the risk of variceal data in five. The origin of cirrhosis was alcoholic in nine patients, posthepatitic in three, and cryptogenic in two. All of these patients bleeding. In a double-blind, placebo-controlled study, we fested by a significant reduction in heart rate (Ï21% { sured with a Toshiba Sonolayer SSA 270 (Tokyo, Japan), a duplex scanner consisting of a real-time, two-dimensional ultrasonic device 4%, P Ú .01) and cardiac output (Ï12% Ô 2%, P Ú .05). A and an attached 3.5-MHz pulse Doppler flowmeter. After a sampling significant decrease in portal blood flow (Ï20% Ô 4%, P marker had been set in the middle of the lumen of the portal vein Ú .01) was also observed in these patients. Propranolol along the beam axis, a second marker was positioned parallel to the administration blunted the time-related changes in cardirection of blood flow. Care was taken to maintain the angle formed diac output and portal blood flow. In contrast, patients by the ultrasonic beam and blood flow direction below 60Њ because the receiving placebo had a nocturnal peak of both parame-accuracy of the hemodynamic measurements decreases at increasing ters similar to that observed under basal conditions. Our angles. Measurements were carried out during expiration because study shows that chronic propranolol administration they can be easily standardized, allowing for a better visualization abolishes the nocturnal peak of portal blood flow in pa-of the portal vein for Doppler purposes, as the angle formed by the ultrasonic beam and blood flow direction is reduced to a minimum. duce the risk of variceal bleeding. [5][6][7][8] The purpose of the presTwenty-Four Hour Study. The patients were admitted to hospital ent randomized study was to evaluate the effect of propranotwo days before the study. During this time, they underwent an lol on the daily fluctuation of systemic and splanchnic acclimation period in a quiet room at 20Њ to 24ЊC. On the day of the hemodynamic parameters in patients with cirrhosis. baseline study, systemic and portal hemodynamic parameters were measured at 0800, 1600, 2400, and 0800 hours. During this period, the patients pursued ordinary activities within the room. HemodyFrom the 1 Seccion Ecografia and the 3 Unidad de Higado, Hospital Dr Bonorino Udaondo, namic studies were performed at least two hours after meals and tients with cirrhosis and indicates a preventive effect of

show abstract

“…2 Unfortunately, nonselective ␤-blockers achieve target reductions in hepatic venous pressure gradient in only approximately one third of patients. [3][4][5] Moreover, endoscopic injection sclerotherapy (EIS) has been replaced almost universally by endoscopic variceal ligation (EVL), because variceal eradication is faster and provides a lower variceal rebleeding rate with fewer secondary effects than in EIS. [6][7][8][9][10][11][12][13] In addition, a meta-analysis has shown a lower mortality in EVL than in EIS.…”

mentioning

confidence: 99%

Variceal ligation plus nadolol compared with ligation for prophylaxis of variceal rebleeding: A multicenter trial

et al. 2005

View full text Add to dashboard Cite

and the EVL Study Group ␤-Blockers and endoscopic variceal ligation (EVL) have proven to be valuable methods in the prevention of variceal rebleeding. The aim of this study was to compare the efficacy of EVL combined with nadolol versus EVL alone as secondary prophylaxis for variceal bleeding. Patients admitted for acute variceal bleeding were treated during emergency endoscopy with EVL or sclerotherapy and received somatostatin for 5 days. At that point, patients were randomized to receive EVL plus nadolol or EVL alone. EVL sessions were repeated every 10 to 12 days until the varices were eradicated. Eighty patients with cirrhosis (alcoholic origin in 66%) were included (Child-Turcotte-Pugh A, 15%; B, 56%; C, 29%). The median follow-up period was 16 months (range, 1-24 months). The variceal bleeding recurrence rate was 14% in the EVL plus nadolol group and 38% in the EVL group (P ‫؍‬ .006). Mortality was similar in both groups: five patients (11.6%) died in the combined therapy group and four patients (10.8%) died in the EVL group. There were no significant differences in the number of EVL sessions to eradicate varices: 3.2 ؎ 1.3 in the combined therapy group versus 3.5 ؎ 1.3 in the EVL alone group. The actuarial probability of variceal recurrence at 1 year was lower in the EVL plus nadolol group (54%) than in the EVL group (77%; P ‫؍‬ .06). Adverse effects resulting from nadolol were observed in 11% of the patients. In conclusion, nadolol plus EVL reduces the incidence of variceal rebleeding compared with EVL alone. A combined treatment could lower the probability of variceal recurrence after eradication. V ariceal bleeding is a serious complication of portal hypertension and a leading cause of death in patients with liver cirrhosis. The patients who survive an initial episode have a risk of rebleeding approaching 80% at 2 years. 1 After the first episode of hemorrhage from esophageal varices, ␤-blockers and endoscopic treatment are effective therapies in the secondary prevention of variceal bleeding. 2 Unfortunately, nonselective ␤-blockers achieve target reductions in hepatic venous pressure gradient in only approximately one third of patients. [3][4][5] Moreover, endoscopic injection sclerotherapy (EIS) has been replaced almost universally by endoscopic variceal ligation (EVL), because variceal eradication is faster and provides a lower variceal rebleeding rate with fewer secondary effects than in EIS. [6][7][8][9][10][11][12][13] In addition, a meta-analysis has shown a lower mortality in EVL than in EIS. 14 Some studies comparing band ligation with ␤-blockers plus isosorbide mononitrate show contradictory results regarding the effectiveness of both treatments in the prevention of variceal rebleeding. [15][16][17] The rationale behind the use of a combination therapy is that agents acting through different mechanisms may have additive or even synergistic benefits. 5 There are few studies analyzing the efficacy of associating both therapeutic methods, ␤-blockers and EVL, in the prevention of recurrent hemor...

show abstract

Effects of Propranolol on Azygos Venous Blood Flow and Hepatic and Systemic Hemodynamics in Cirrhosis

Cited by 299 publications

References 16 publications

Effects of propranolol on the hepatic hemodynamic response to physical exercise in patients with cirrhosis

Effects of propranolol on the hepatic hemodynamic response to physical exercise in patients with cirrhosis

Daily variation in portal blood flow and the effect of propranolol administration in a randomized study of patients with cirrhosis

Variceal ligation plus nadolol compared with ligation for prophylaxis of variceal rebleeding: A multicenter trial

Contact Info

Product

Resources

About