Total effective vascular compliance in patients with cirrhosis. Effects of propranolol.
BACKGROUND
Total effective vascular compliance (TEVC), may be increased in cirrhosis. However, its significance is unclear.


OBJECTIVE
To investigate TEVC in patients with cirrhosis, and the effects of propranolol.


METHODS
Seven patients without liver disease and 44 cirrhotic patients were studied before and after double-blind administration of propranolol (n=33) or placebo (n=11).


METHODS
TEVC (right atrial pressure response to rapid central volume expansion), hepatic venous pressure gradient (HVPG) and systemic hemodynamics.


RESULTS
TEVC (ml x mmHg(-1) x kg(-1)) was increased in cirrhotics (1.67 +/- 0.66 versus 1.33 +/- 0.32 in controls; P<0.05). TEVC was not modified by placebo, but was markedly reduced by propranolol (from 1.74 +/- 0.75 to 1.33 +/- 0.56; P<0.01). Propranolol decreased HVPG >10% in 20 patients ('responders': -20 +/- 9%) but <10% in 13 'non-responders'. TEVC was normalized by propranolol in HVPG 'responders' (from 1.76 +/- 0.88 to 1.21 +/- 0.51; P<0.01), but not in 'non-responders' (1.69 +/- 0.48 to 1.52 +/- 0.59; NS). Reduction of TEVC in responders was accompanied by increased free hepatic vein pressure (+21 +/- 20%, P=0.05; approximately 60% of the fall in HVPG), which was not observed in non-responders (+3 +/- 11%, NS).


CONCLUSIONS
TEVC is increased in cirrhosis. This abnormality is corrected by propranolol in patients exhibiting a >10% fall in HVPG, suggesting that changes in vascular compliance may influence the portal pressure response to propranolol.
Andreu
Victoria
V
Liver Unit, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain.
Perello
Antonia
A
Moitinho
Eduardo
E
Escorsell
Angels
A
García-Pagán
Juan-Carlos
JC
Bosch
Jaume
J
Rodés
Joan
J
D003187:Compliance / Q000187:drug effects; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006975:Hypertension, Portal / Q000188:drug therapy / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000188:drug therapy* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011433:Propranolol / Q000627:therapeutic use*; D014665:Vasodilator Agents / Q000627:therapeutic use*
D014665:Vasodilator Agents; D011433:Propranolol