Non-selective β-blockers improve the correlation of liver stiffness and portal pressure in advanced cirrhosis

J Gastroenterol. 2012 May;47(5):561-8. doi: 10.1007/s00535-011-0517-4. Epub 2011 Dec 15.

Abstract

Background: Liver stiffness (LS) correlates with portal pressure (hepatic venous pressure gradient, HVPG). However, the dynamic components of portal hypertension (PHT) in advanced cirrhosis may not be adequately assessed by TE. The influence of treatment with non-selective β-blockers (NSBB) on the correlation of HVPG and LS has not been investigated.

Methods: One hundred and twenty-two patients with esophageal varices were included. LS, hemodynamic parameters, and HVPG were recorded at baseline (BL) and after 6 weeks of treatment with NSBB (FU). The correlation of LS and HVPG was compared to control patients with HVPG ≤ 12 mmHg.

Results: Patients with higher Child-Pugh stages (A:88/B:25/C:9) had higher levels of liver stiffness (47.4 ± 16.5 vs. 70.3 ± 7.9 vs. 73.7 ± 2.1 kPa) and HVPG (21 ± 5 vs. 26 ± 5 vs. 26 ± 4 mmHg). The correlation of LS and HVPG was stronger in controls with HVPG ≤ 12 mmHg (R = 0.951; P < 0.0001) than in patients with HVPG > 12 mmHg (R = 0.538; P = 0.0004). The association of HVPG with LS became stronger under treatment with NSBB, which finally restored the linear correlation of HVPG and LS (R = 0.930; P < 0.0001). Forty-three percent (53/122) of patients were hemodynamic responders to NSBB. The improvement in the correlation of LS and HVPG under NSBB was mainly noted in hemodynamic responders (R = 0.864), but not in nonresponders (R = 0.535), whereas changes in LS, heart rate, and MAP were similar in responders and nonresponders.

Conclusions: Targeting the hyperdynamic circulation and the increased splanchnic blood inflow by treatment with NSBB unmasks the linear (mechanical) correlation of HVPG and LS in patients with HVPG > 12 mmHg. Measurement of LS by TE is not a feasible method to assess the dynamic components of PHT.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenergic beta-Antagonists / pharmacology*
  • Adrenergic beta-Antagonists / therapeutic use
  • Adult
  • Carbazoles / pharmacology
  • Carbazoles / therapeutic use
  • Carvedilol
  • Elasticity / drug effects
  • Elasticity Imaging Techniques / methods
  • Esophageal and Gastric Varices / complications
  • Esophageal and Gastric Varices / physiopathology
  • Feasibility Studies
  • Female
  • Gastrointestinal Hemorrhage / etiology
  • Gastrointestinal Hemorrhage / physiopathology
  • Gastrointestinal Hemorrhage / prevention & control
  • Hemodynamics / drug effects
  • Hemodynamics / physiology
  • Humans
  • Hypertension, Portal / diagnostic imaging
  • Hypertension, Portal / etiology
  • Hypertension, Portal / physiopathology
  • Liver / physiopathology*
  • Liver Cirrhosis / complications
  • Liver Cirrhosis / diagnostic imaging
  • Liver Cirrhosis / drug therapy*
  • Liver Cirrhosis / physiopathology
  • Male
  • Middle Aged
  • Portal Pressure / drug effects*
  • Portal Pressure / physiology
  • Propanolamines / pharmacology
  • Propanolamines / therapeutic use
  • Propranolol / pharmacology
  • Propranolol / therapeutic use
  • Prospective Studies

Substances

  • Adrenergic beta-Antagonists
  • Carbazoles
  • Propanolamines
  • Carvedilol
  • Propranolol