title: Development of hyperdynamic circulation and response to β-blockers in compensated cirrhosis with portal hypertension.
abstract: Nonselective β-blockers are useful to prevent bleeding in patients with cirrhosis and large varices but not to prevent the development of varices in those with compensated cirrhosis and portal hypertension (PHT). This suggests that the evolutionary stage of PHT may influence the response to β-blockers. To characterize the hemodynamic profile of each stage of PHT in compensated cirrhosis and the response to β-blockers according to stage, we performed a prospective, multicenter (tertiary care setting), cross-sectional study. Hepatic venous pressure gradient (HVPG) and systemic hemodynamic were measured in 273 patients with compensated cirrhosis before and after intravenous propranolol (0.15 mg/kg): 194 patients had an HVPG ≥10 mm Hg (clinically significant PHT [CSPH]), with either no varices (n = 80) or small varices (n = 114), and 79 had an HVPG >5 and <10 mm Hg (subclinical PHT). Patients with CSPH had higher liver stiffness (P < 0.001), worse Model for End-Stage Liver Disease score (P < 0.001), more portosystemic collaterals (P = 0.01) and splenomegaly (P = 0.01) on ultrasound, and lower platelet count (P < 0.001) than those with subclinical PHT. Patients with CSPH had lower systemic vascular resistance (1336 ± 423 versus 1469 ± 335 dyne · s · cm(-5) , P < 0.05) and higher cardiac index (3.3 ± 0.9 versus 2.8 ± 0.4 L/min/m(2) , P < 0.01). After propranolol, the HVPG decreased significantly in both groups, although the reduction was greater in those with CSPH (-16 ± 12% versus -8 ± 9%, P < 0.01). The HVPG decreased ≥10% from baseline in 69% of patients with CSPH versus 35% with subclinical PHT (P < 0.001) and decreased ≥20% in 40% versus 13%, respectively (P = 0.001).
  
  
  CONCLUSIONS
  Patients with subclinical PHT have less hyperdynamic circulation and significantly lower portal pressure reduction after acute β-blockade than those with CSPH, suggesting that β-blockers are more suitable to prevent decompensation of cirrhosis in patients with CSPH than in earlier stages.
authors.affiliation: Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.|Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.
authors.forename: Càndid
authors.initials: C
authors.lastname: Villanueva
authors.affiliation: Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.|Hospital Universitario Ramón y Cajal (IRYCIS), Universidad de Alcalá, Madrid, Spain.
authors.forename: Agustín
authors.initials: A
authors.lastname: Albillos
authors.affiliation: Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.|Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Genescà
authors.affiliation: Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.|Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Institut Malalties Digestives i Metaboliques, IDIBAPS, Hospital Clínic, Barcelona, Spain.
authors.forename: Juan G
authors.initials: JG
authors.lastname: Abraldes
authors.affiliation: Clínica Puerta de Hierro, Madrid, Spain.
authors.forename: Jose L
authors.initials: JL
authors.lastname: Calleja
authors.affiliation: Hospital Arnau de Vilanova, Lleida, Spain.
authors.forename: Carles
authors.initials: C
authors.lastname: Aracil
authors.affiliation: Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.|Hospital General Universitario Gregorio Marañón (IISGM), Facultad de Medicina, Universidad Complutense, Madrid, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Bañares
authors.affiliation: Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.|Hospital Germans Trias, Badalona, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Morillas
authors.affiliation: Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.|Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Poca
authors.affiliation: Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.|Hospital Universitario Ramón y Cajal (IRYCIS), Universidad de Alcalá, Madrid, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Peñas
authors.affiliation: Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.|Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Salvador
authors.initials: S
authors.lastname: Augustin
authors.affiliation: Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.|Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Institut Malalties Digestives i Metaboliques, IDIBAPS, Hospital Clínic, Barcelona, Spain.
authors.forename: Joan Carles
authors.initials: JC
authors.lastname: Garcia-Pagan
authors.affiliation: Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.|Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.
authors.forename: Oana
authors.initials: O
authors.lastname: Pavel
authors.affiliation: Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.|Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Institut Malalties Digestives i Metaboliques, IDIBAPS, Hospital Clínic, Barcelona, Spain.
authors.forename: Jaume
authors.initials: J
authors.lastname: Bosch
mesh_terms: D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000494:pharmacology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004311:Double-Blind Method; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000503:physiopathology*; D008103:Liver Cirrhosis / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011433:Propranolol / Q000494:pharmacology*; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D000319:Adrenergic beta-Antagonists; D011433:Propranolol