SHORT-TERM AND LONG-TERM HEMODYNAMIC-RESPONSE TO OCTREOTIDE IN PORTALHYPERTENSIVE PATIENTS - A DOUBLE-BLIND, CONTROLLED-STUDY

This randomized, double-blind, placebo-controlled study on the hemodyn amic effect of two different doses of octreotide administered subcutan eously was conducted among 20 cirrhotic portal hypertensive patients. The wedged hepatic venous pressure, the hepatic venous pressure gradie nt, the mean portal venous flow velocity, the resistive index of the s uperior mesenteric artery, the heart rate and the mean arterial pressu re were simultaneously evaluated by hepatic vein catheterization and D oppler flowmetry at baseline, 30 and 45 min after a subcutaneous injec tion of octreotide [0.10 mg (7 patients), 0.05 mg (7 patients)] and of a placebo (6 patients). The portal blood how velocity, the resistive index of the superior mesenteric artery, the heart rate and the mean a rterial pressure were also measured 2, 4, 6 and 8 h after the injectio n. The hemodynamic changes observed 30 min after the injection did not differ from those at 45 min and the changes at 2, 4, and 6 h were sim ilar to those at 8 h. A statistically significant decrease, in compari son to the placebo group, was observed 45 min after the injection of t he two doses of octreotide in the wedged hepatic venous pressure (cumu lative median decrease: -10%, p<0.005), in the hepatic venous pressure gradient (cumulative median decrease: -10%, p<0.005) and in the mean portal flow velocity (cumulative median decrease: -11%, p<0.005). A si gnificant increase in the resistive index of the superior mesenteric a rtery was observed 45 min after the injection of the two doses of octr eotide (cumulative median increase: +10%, p<0.005). Lower, but signifi cant changes in the mean portal flow velocity and in the resistive ind ex of the superior mesenteric artery persisted until 8 h after the inj ection of the two doses of octreotide (cumulative median decrease of m ean portal how velocity: -7%, p<0.005 and cumulative median increase o f resistive index of the superior mesenteric artery: +4%, p<0.005). Ch anges in the wedged hepatic venous pressure, the hepatic venous pressu re gradient, the mean portal flow velocity and the resistive index of the superior mesenteric artery showed a great variability among patien ts. These changes were more pronounced in patients injected with the l ower dose with no relationship with the plasma drug concentrations. Re sponder patients showed a significant higher baseline mean portal flow velocity in comparison with nonresponders (15.2+/-1.7 cm/s vs 11.3+/- 1.3 cm/s; p<0.005).