Background/Aims: 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...Background/Aims: 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-res-ponders 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.展开更多
基金a grant on Vascular Disorders of the Liver from Dipartimento di Medicina Interna, Cardioangiologia, Epatologia, Universita di Bologna to Dr. A Berzigotti
文摘Background/Aims: 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-res-ponders 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.
