Aims: To analyze the changes in portal pressure, blood flow and resistance after propranolol administration, and to assess the predictive value of the variations of Doppler Duplex Ultrasonography (DDU) measurements according to the response of the hepatic venous pressure gradient (HVPG).
Patients & methods: 30 cirrhotic patients were studied. Assessment of systemic hemodynamics and HVPG were performed in baseline and after intravenous propranolol administration (0.15 mg/kg). Patients who showed a decrease > or = 20% &/or < 12 mm/Hg in HVPG were considered responders. The DDU study was performed in blind conditions, in baseline and after propranolol. Measurement of blood flow of the portal vein, splenic vein and femoral artery were performed. Portal resistance was calculated as HVPG/portal blood flow.
Results: All patients were beta blocked and 14 (47%) were responders. There were no significant differences in systemic or splachnic hemodynamic baseline data between responders and non responders. Femoral blood flow decreased in both groups. Splenic and portal blood flow decreased significantly only in responders. No significant difference was found in the variation of portal resistance between responders and non responders; when these changes were considered individually, a great variability was found in both groups. A decrease > or = 15% in splenic blood flow showed a positive predictive value of 88%, a lack of a similar decrease in portal blood flow showed a negative predictive value of 86%.
Conclusions: The decrease in portal blood flow was the main factor in determining the response to propranolol.