Duplex Doppler ultrasonography allows a multiorgan noninvasive approach to splanchnic pharmacodynamics in patients with cirrhosis.
Duplex Doppler ultrasonography (DDU) is a suitable method to evaluate acute splanchnic hemodynamic effects of vasoactive drugs. It allows the contemporary evaluation of arterial and venous splanchnic parameters. Forty-six cirrhotic patients with esophageal varices were investigated by DDU. Portal blood flow mean velocity (PBV) (cm/s), portal blood flow volume (PBF) (ml/min), pulsatility index (PI) [(maximum-minimum)/mean velocity] in the superior mesenteric artery, in intrahepatic arteries (main branches), in an instrasplenic artery, and in interlobar arteries of the kidneys were measured before and 120-180 min after the administration of nadolol (80 mg p.o.) in 24 patients, and before and 120 min after placebo administration in 9 patients. In 13 patients who were chronically treated with nadolol, DDU parameters were evaluated before and 90 min after the administration of isosorbide-5-mononitrate (20 mg p.o.).


RESULTS
placebo caused no hemodynamic change. After nadolol, heart rate decreased (-22 +/- 8%), and so did PBV and PBF (8.8 +/- 3.4 vs. 10.9 +/- 3.2, -20 +/- 17%, p < 0.0001; 660 +/- 347 vs. 852 +/- 371, -24 +/- 18%, p < 0.0001). Mesenteric PI increased (2.72 +/- 0.67 vs. 2.28 +/- 0.56, +21 +/- 25%, p = 0.005). Hepatic, splenic, and renal PIs showed slight, not significant changes (1.42 +/- 0.41 vs. 1.38 +/- 0.32, p = NS; 1.05 +/- 0.23 vs. 0.99 +/- 0.21, p = NS; 1.24 +/- 0.26 vs. 1.19 +/- 0.20, p = NS, respectively). After the administration of isosorbide-5-mononitrate, PBV decreased (8.2 +/- 2.0 vs. 9.4 +/- 2.3, -12 +/- 13%, p = 0.006), while PBF did not modify (648 +/- 189 vs. 711 +/- 209, p = NS).(ABSTRACT TRUNCATED AT 250 WORDS)
Bolognesi
M
M
Centro di Spleno-Epatologia, Università di Padova, Policlinico Universitario, Italy.
Sacerdoti
D
D
Merkel
C
C
Caregaro
L
L
Bellon
S
S
Gatta
A
A
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity / Q000187:drug effects / Q000502:physiology; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D004359:Drug Therapy, Combination; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000503:physiopathology; D005260:Female; D006439:Hemodynamics / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D006975:Hypertension, Portal / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology; D007548:Isosorbide Dinitrate / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D007668:Kidney / Q000098:blood supply; D008099:Liver / Q000098:blood supply; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging / Q000187:drug effects; D008875:Middle Aged; D009248:Nadolol / Q000008:administration & dosage* / Q000009:adverse effects; D011673:Pulsatile Flow / Q000187:drug effects / Q000502:physiology; D013152:Splanchnic Circulation / Q000187:drug effects* / Q000502:physiology; D018615:Ultrasonography, Doppler, Color / Q000187:drug effects; D014655:Vascular Resistance / Q000187:drug effects / Q000502:physiology; D014665:Vasodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects
D014665:Vasodilator Agents; D009248:Nadolol; D007548:Isosorbide Dinitrate; C030397:isosorbide-5-mononitrate