Non-selective beta-blockers impair global circulatory homeostasis and renal function in cirrhotic patients with refractory ascites

Non-selective beta-blockers impair global circulatory homeostasis and renal function in cirrhotic patients with refractory ascites

The safety of non-selective β-blockers (NSBBs) has been questioned in refractory ascites (RA). We studied the effects of NSBBs on cardiac systolic function, systemic hemodynamics, and renal perfusion pressure (RPP) and function in patients with diuretic-responsive ascites (DRA) and RA. We performed...

Full description

Saved in:
Bibliographic Details
Published in:Journal of hepatology 2020-12, Vol.73 (6), p.1404-1414
Main Authors: Téllez, Luis, Ibáñez-Samaniego, Luis, Pérez del Villar, Candelas, Yotti, Raquel, Martínez, Javier, Carrión, Laura, Rodríguez de Santiago, Enrique, Rivera, Maite, González-Mansilla, Ana, Pastor, Óscar, Bermejo, Javier, Bañares, Rafael, Albillos, Agustín
Format: Article
Language:eng
Subjects:
Ascites
Beta blockers
Cirrhosis
Cirrhotic cardiomyopathy
Diuretics
Glomerular filtration rate
Heart rate
Hemodynamics
Hepatorenal syndrome
Homeostasis
Inotropic heart dysfunction
Interleukin 6
Nitric oxide
Norepinephrine
Perfusion
Portal hypertension
Pressure
Prophylaxis
Propranolol
Renal function
Renal perfusion pressure
Resistive renal index
Systolic dysfunction
Variceal bleeding
Vasodilation
Ventricle
Window hypothesis
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:The safety of non-selective β-blockers (NSBBs) has been questioned in refractory ascites (RA). We studied the effects of NSBBs on cardiac systolic function, systemic hemodynamics, and renal perfusion pressure (RPP) and function in patients with diuretic-responsive ascites (DRA) and RA. We performed a prospective pre-post repeated-measures study in cirrhotic patients, 18 with DRA and 20 with RA on NSBBs for variceal bleeding prophylaxis. Systolic function (by ejection intraventricular pressure difference [EIVPD]), hepatic venous pressure gradient (HVPG), cardiopulmonary pressures, RPP, and sympathetic activation were measured at baseline and after 4 weeks of propranolol. EIVPD was elevated at baseline (RA 4.5 [2.8–5.7] and DRA 4.2 [3.1–5.7] mmHg; normal 2.4–3.6 mmHg) and directly related to the severity of vasodilation and sympathetic activation. NSBBs led to similar reductions in heart rate and HVPG in both groups. NSBBs reduced EIPVD in RA but not in DRA (−20% vs. −2%, p 0.40, all p 0.40, all p
ISSN:0168-8278
1600-0641