Primary prophylaxis with nadolol in cirrhotic patients: Doppler patterns of splanchnic hemodynamics in good and poor responders.
OBJECTIVE
We aimed to characterize by echo-color-Doppler the splanchnic hemodynamics of patients good and poor responders to primary prophylaxis with nadolol.


METHODS
Thirty cirrhotic patients (Child-score 7.0+/-1.8) with medium/large esophageal varices without previous bleedings were consecutively enrolled. At inclusion and after 3 months of treatment with nadolol, they underwent a splanchnic echo-color-Doppler study and a measurement of hepatic venous pressure gradient (HVPG).


RESULTS
Nadolol (60+/-36 mg/day; range 20-160) induced a significant reduction of HVPG (16.6+/-6.1 vs. 19.4+/-4.6 mmHg, P < 0.0001). 13 patients (43.3%) were hemodynamic responders. Responders and Poor-responders had similar baseline clinical characteristics. Poor-responders at baseline were characterized by lower impedance indexes in superior mesenteric artery (SMA) (PI 2.29+/-0.45 vs. 2.74+/-0.46; P = 0.01; RI 0.83+/-0.04 vs. 0.86+/-0.03; P = 0.02), hepatic artery (HA) (PI 1.41+/-0.19 vs. 1.79+/-0.48; P = 0.03; RI 0.71+/-0.05 vs. 0.80+/-0.07; P = 0.02), and splenic artery (SA) (PI 1.18+/-0.27 vs. 1.73+/-0.40; P = 0.01; RI 0.66+/-0.07 vs. 0.73+/-0.09; P = 0.02), and by higher mean flow velocity of HA (52.6+/-21.6 vs. 26.5+/-9.5 cm/s; P = 0.02) and SMA (49.7+/-14.5 vs. 33.9+/-13.1 cm/s; P = 0.06).


CONCLUSIONS
Cirrhotic patients poor-responders to nadolol show a pronounced arterial splanchnic vasodilatation at a baseline echo-color-Doppler study. This can be considered a non-invasive clue for the a priori identification of this subgroup of patients.
Berzigotti
Annalisa
A
Dipartimento di Medicina Interna, Cardioangiologia, Epatologia, Policlinico S. Orsola-Malpighi, Via Albertoni 15, 40138 Bologna, Italy.
Rinaldi
Maria Francesca
MF
Magalotti
Donatella
D
Morelli
Maria Cristina
MC
Zappoli
Paola
P
Andreone
Pietro
P
Rossi
Cristina
C
Zoli
Marco
M
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D001783:Blood Flow Velocity / Q000187:drug effects / Q000502:physiology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006503:Hepatic Veins / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D008103:Liver Cirrhosis / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008297:Male; D008638:Mesenteric Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology; D008875:Middle Aged; D009248:Nadolol / Q000627:therapeutic use*; D011322:Primary Prevention / Q000379:methods*; D011446:Prospective Studies; D013152:Splanchnic Circulation / Q000187:drug effects / Q000502:physiology*; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014661:Vasoconstriction / Q000187:drug effects
D000319:Adrenergic beta-Antagonists; D009248:Nadolol