ACCURACY OF PORTAL AND FOREARM BLOOD-FLOW MEASUREMENTS IN THE ASSESSMENT OF THE PORTAL PRESSURE RESPONSE TO PROPANOLOL

Background/Aims: The portal pressure response to propranolol varies si gnificantly in individual patients with cirrhosis. At present, propran olol responders cars be identified only by measuring the hepatic venou s pressure gradient, The aims of this study were: 1) to investigate wh ether the noninvasive monitoring of portal blood flow by pulsed Dopple r ultrasound and forearm blood flow by strain-gauge plethysmography; c an predict the hepatic venous pressure gradient response to propranolo l ire patients with cirrhosis, and 2) to analyze the factors that may influence this response. Methods: Hemodynamic measurements were under- taken in 80 patients with cirrhosis before and after receiving propran olol (0.15 mg/kg i.v., n=60) or placebo (n=20). Results: Ne changes we re observed in the placebo group, Propranolol lowered (p<0.01) hepatic venous pressure gradient from 17.6+/-3.8 to 14.7+/-3.8 mmHg, portal b lood flow from 1122+/-363 to 897+/-332 ml/min and forearm blood flow f rom 7.52+/-3.1 to 6.12+/-2.3 ml/min%. Changes in hepatic venous pressu re gradient were correlated (p<0.01) with those of portal blood flow ( r=0.82) and forearm blood flow (r=0.54). The reduction in hepatic veno us pressure gradient was >20% in 23 patients (''responders''). The acc uracy of portal Doppler flowmetry in identifying responders was higher than that of forearm plethysmography (88.3 vs, 68.3%, p<0.05). Multiv ariate analysis proved that previous variceal bleeding was the only fa ctor independently associated with a lack of response to propranolol ( relative risk 3.42, 95% CI 1.5-7.4, p<0.01). Hepatic venous pressure g radient reduction by propranolol was higher in pion-bleeders than in b leeders (-19.9+/-9.4 vs, -11.3+/-8.6%, p<0.01). Conclusions: Portal Do ppler ultrasound can he used as a reliable surrogate indicator of the hepatic venous pressure gradient response to acute propranolol adminis tration. Hn addition, our study indicates that this response is mainly influenced by previous variceal hemorrhage.