SHORT-TERM CARDIOVASCULAR EFFECTS OF SOMATOSTATIN IN PATIENTS WITH CIRRHOSIS

Somatostatin is used to treat variceal hemorrhage in patients with cir rhosis and portal hypertension. Its systemic hemodynamic effects, howe ver, are not yet well defined. Since cardiomyopathy or pulmonary arter y hypertension may occur ill patients with cirrhosis, definition of th e systemic hemodynamic effects of somatostatin or its analogue octreot ide is of clinical importance. The aim of this study was to evaluate t he effects of somatostatin, at different doses and under different con ditions of administration, on the systemic hemodynamics in 17 patients with cirrhosis. Two sets of experiments were performed. In the first, eight patients received two different bolus doses (100 and 250 mu g) of somatostatin. The second set of experiments was designed to study t he hemodynamic effects of the combination of a bolus and an infusion o f somatostatin. Nine other patients received one bolus of 250 mu g of somatostatin, followed by a 250 mu g/h infusion for 65 min. A second b olus of 250 mu g of somatostatin was injected in these patients after 35 min of infusion. Before and for 30 min after each bolus, systemic h emodynamics were measured. Following a bolus of somatostatin, a dose-d ependent decrease in heart rate (from 77 +/- 3 to 73 +/- 5 beats/min w ith 100 mu g, and from 78 +/- 4 to 68 +/- 5 beats/min with 250 mu g, p < 0.05) and increases in systemic and pulmonary artery pressures were observed. The combination of an infusion and a bolus of somatostatin significantly reduced the increases in systemic and pulmonary artery p ressures. These results suggest that a combination of an infusion and a bolus of somatostatin might have less deleterious effects on systemi c hemodynamics than a bolus alone.