Comparison of portal vein velocity and the hepatic venous pressure gradient in assessing the acute portal hemodynamic response to propranolol in patients with cirrhosis.
OBJECTIVE
The aim of this prospective study was to compare noninvasive Doppler sonography and invasive measurement of the hepatic venous pressure gradient (HVPG) to determine the acute portal hemodynamic response to propranolol in patients with liver cirrhosis.


METHODS
In a blinded study design, portal vein velocity (PVV) and HVPG were simultaneously assessed in 11 cirrhotic patients for 4 h after oral ingestion of 40 mg propranolol.


RESULTS
Both HVPG (17.2% +/- 4.3%, p < 0.0001) and PVV (15.6% +/- 2.1%, p < 0.0002) showed a highly significant reduction during the study period versus baseline. Based on HVPG measurements, four patients (36%) were classified as nonresponders. These patients had a significantly lower PVV reduction compared to the responders (responders: 18.8% +/- 2.0% vs nonresponders: 10.0% +/- 2.1%, p < 0.05). Nonresponders were identified by Doppler sonography with a sensitivity of 1.0, specificity of 0.86, and positive predictive value of 0.9 when a threshold of 20% PVV reduction 120 min after drug intake was applied.


CONCLUSIONS
Doppler sonography is a useful tool for assessment of the acute portal hemodynamic effect of propranolol. To distinguish portal hemodynamic nonresponders from responders to propranolol, PVV measurements should be carried out 2 h after drug administration, and PVV reduction should be not <20% in propranolol responders.
Schepke
M
M
Department of Internal Medicine I, University of Bonn, Germany.
Raab
P
P
Hoppe
A
A
Schiedermaier
P
P
Brensing
K A
KA
Sauerbruch
T
T
D000284:Administration, Oral; D001783:Blood Flow Velocity / Q000187:drug effects / Q000502:physiology; D005260:Female; D006439:Hemodynamics / Q000187:drug effects* / Q000502:physiology; D006503:Hepatic Veins / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000503:physiopathology; D006801:Humans; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure / Q000187:drug effects* / Q000502:physiology; D011168:Portal System / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000503:physiopathology; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000503:physiopathology; D011433:Propranolol / Q000008:administration & dosage* / Q000009:adverse effects; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler / Q000187:drug effects
D011433:Propranolol