Impact of non-selective beta blockers on portal hypertension and hepatic elasticity in hepatitis C virus-related liver cirrhosis

Abstract

Portal hypertension and its complications are the leading causes of morbidity and mortality in patients with liver cirrhosis. Noninvasive assessment of liver stiffness had been an effective tool for assessment of fibrosis progression in chronic liver disease. It was intended to assess liver stiffness measurement (LSM), portal vein diameter (PVD), splenic bipolar diameter (SD), and the platelet count/spleen diameter (PC/SD) ratio in patients who test positive for the hepatitis C virus (HCV) and to study the impact of non-selective beta blockers (NSBB) on the grade of esophageal varices (EVs) and liver elasticity. Subjects were 80 patients with Child-Pugh grade A or B compensated cirrhosis who tested positive for HCV. All of the patients underwent a laboratory workup including AFP, HCV antibodies, HCV RNA, HBsAg, LSM according to real-time elastography, upper gastrointestinal endoscopy (UGIE) to detect and grade EVs, calculation of the PC/SD ratio, and measurement of the PVD and SD according to real-time abdominal ultrasonography. All patients were given the maximum tolerated dose of NSBB for three months, and UGIE, LSM, PC/SD, PVD, and SD were subsequently reassessed and reported. LSM and the PC/SD ratio were exceptional noninvasive tools for prediction of significant EVs (grade ≥ II, p < 0.001) with a sensitivity 82.4% and a specificity 82.6% at a cutoff point 18 kPa for LSM, and a sensitivity 94.1% and specificity 69.6% at a cutoff point 880 for the PC/SD ratio. LSM is highly correlated with PVD, the PC/SD ratio, SD, and the Child-Pugh score. NSBB significantly decreased PVD. The percent change in PVD significantly correlated with LSM, the grade of EVs, and SD. Findings indicated that LSM is a noninvasive, rapid, and reproducible tool with which to detect portal hypertension and EVs. NSBB therapy can effectively decrease PVD and may consequently improve the EV grade with no significant impact on LSM in patients with liver cirrhosis.

Using MR elastography to assess portal hypertension and response to beta‐blockers in patients with cirrhosis

“…show that the effects of NSBB or combined alpha-betablockers on LS are heterogeneous-sometimes decreasing, other times increasing, LS. [11][12][13][14][15]28 The ultrasound-based study by Choi et al found similar both increasing and decreasing LS after NSBB, but they showed a strong correlation between changes in LS and changes in HVPG.…”

“…Spleen stiffness optimal cut-off was an increase in spleen stiffness of 0.3 kPa after NSBB, and the area under the ROC curve was 0.53 (CI 0.32-0.75) (B), with a specificity of 1.00 and a sensitivity 0.19 show that the effects of NSBB or combined alpha-betablockers on LS are heterogeneous-sometimes decreasing, other times increasing, LS. [11][12][13][14][15]28 The ultrasound-based study by Choi et al found similar both increasing and decreasing LS after NSBB, but they showed a strong correlation between changes in LS and changes in HVPG.…”

“…8,9 Currently, response to NSBB is measured during a liver vein catheterization, which is an invasive and costly procedure that at present has no reliable, noninvasive alternatives. 10 The few ultrasound-based elastography studies that have been carried out have shown a heterogeneous effect of NSBB on LS and SS [11][12][13][14][15] and, to our knowledge, no study has previously evaluated the effects of NSBB on LS and SS using MR elastography. In this study, we therefore aimed to evaluate whether (i) MR elastography of the spleen or liver can be used to classify the degree of portal hypertension, (ii) intravenously administered NSBB can affect LS and SS in patients with severe portal hypertension, and (iii) changes in MR elastography can predict the treatment effect of NSBB on HVPG.…”

Bibliometric-analysis visualization and review of non-invasive methods for monitoring and managing the portal hypertension

“…As far as detecting changes in portal pressure after various therapies, LSM was unreliable in evaluating the effect of NSBB, and NSBB could not significantly change the stiffness of the liver ( 122 ). While hemodynamic factors such as SSM and the portal vein diameter showed a correlation with the changed PH ( 104 , 108 , 133 ). In the situation of antiviral therapy, SSM could also reflect changes in portal hypertension ( 134 ).…”

Studi Penggunaan Obat Golongan Beta-Blocker Pada Pasien Rawat Inap Rumah Sakit Ansari Saleh Banjarmasin

“…Non selektif beta blocker seperti propranolol dan nadolol, pada pasien sirosis digunakan untuk menurunkan hipertensi portal dan mencegah perdarahan varises (Angeli et al, 2018). Propranolol merupakan non selektif beta-blocker yang paling banyak digunakan pada pasien sirosis (Zaghloul et al, 2019). Propranolol pada pasien sirosis hepatik terbukti efektif dalam menurunkan hipertensi portal dan mencegah terjadinya perdarahan varises serta mengurangi resiko komplikasi lain (Angeli et al, 2018).…”