title: Non-invasive Diagnosis of Oesophageal Varices Using Systemic Haemodynamic Measurements by Finometry: Comparison with Other Non-invasive Predictive Scores.
abstract: OBJECTIVE
  Cirrhosis and portal hypertension are characterised by a hyperdynamic circulation, which is independently associated with variceal size. Non-invasive techniques for measurement of systemic haemodynamics are now available. The aim of the study was to prospectively assess the accuracy of systemic haemodynamics measured non-invasively for the detection of oesophageal varices in cirrhotic patients as compared to other currently available non-invasive methods.
  
  
  METHODS
  In a study of 29 cirrhotic patients, systemic haemodynamics were studied non-invasively using the Finometer®(mean arterial pressure (MAP), cardiac output (CO)/index, heart rate (HR), peripheral vascular resistance) and portal pressure was assessed by hepatic venous pressure gradient. Sensitivity, specificity, predictive values and area under the receiver operating characteristic (ROC) curves were assessed for predicting presence of varices and large oesophageal varices. Results were compared to child's classification, platelet/spleen ratio and ALT/AST ratios as predictors of the presence of large varices.
  
  
  RESULTS
  Using finometry large oesophageal varices were correctly predicted in 83% of patients compared to other non-invasive techniques (range 66-76%).
  
  
  CONCLUSIONS
  Non-invasive assessment of systemic haemodynamics using finometry could aid the identification of patients who do not immediately require variceal surveillance reducing the numbers of endoscopies and ensuring services are provided to those most likely to benefit.
authors.affiliation: Liver Unit, Royal Derby Hospital, Uttoxeter Road, Derby DE22 3NE, United Kingdom.
authors.forename: Kara
authors.initials: K
authors.lastname: Rye
authors.affiliation: Liver Unit, Royal Derby Hospital, Uttoxeter Road, Derby DE22 3NE, United Kingdom.
authors.forename: Gerri
authors.initials: G
authors.lastname: Mortimore
authors.affiliation: Liver Unit, Royal Derby Hospital, Uttoxeter Road, Derby DE22 3NE, United Kingdom.
authors.forename: Andrew
authors.initials: A
authors.lastname: Austin
authors.affiliation: Liver Unit, Royal Derby Hospital, Uttoxeter Road, Derby DE22 3NE, United Kingdom.
authors.forename: Jan
authors.initials: J
authors.lastname: Freeman
keywords: AAR, AST/ALT ratio; CI, cardiac index; CO, cardiac output; DBP, diastolic blood pressure; HR, heart rate; HVPG, hepatic venous pressure gradient; IQR, interquartile range; LOV, large oesophageal varices; LR+, positive likelihood ratio; LR−, negative likelihood ratio; MAP, mean arterial pressure; MELD, model of end stage liver disease; NIEC, North Italian Endoscopy Club; NPV, negative predictive value; PPV, positive predictive value; PSDR, platelet count-to spleen diameter ratio; PT, prothrombin time; PVR, peripheral resistance; ROC, receiver operating characteristic; SBP, systolic blood pressure; SV, stroke volume; Se, sensitivity; Sp, specificity; finometry; non-invasive predictive scores; oesophageal varices; systemic haemodynamics