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Acute hemodynamic response to beta-blockers and prediction of long-term outcome in primary prophylaxis of variceal bleeding.
Gastroenterology. 2009 Jul; 137(1):119-28.G

Abstract

BACKGROUND & AIMS

Studies of variceal bleeding have shown that a hemodynamic response to treatment of portal hypertension is appropriate when the hepatic venous pressure gradient (HVPG) decreases below 12 mmHg or by > 20% from baseline. However, in primary prophylaxis, many nonresponders do not bleed and 2 invasive procedures are needed to assess response. We investigated the long-term prognostic value of an acute response to beta-blockers and whether the target reduction in HVPG can be improved in primary prophylaxis.

METHODS

An initial hemodynamic study was performed in patients with large varices and without previous bleeding. After baseline measurements were made, propranolol was administered intravenously and measurements were repeated 20 minutes later. Patients were given nadolol daily and a second hemodynamic study was performed.

RESULTS

Of 105 patients, 15% had variceal bleeding. Using receiver operating characteristic curve analysis, a decrease of HVPG > or = 10% was the best value to predict bleeding. In the initial study, 75 patients (71%) were responders (HVPG decreased to < or = 12 mmHg or by > or = 10%) and had a lower probability of first bleeding than nonresponders (4% vs 46% at 24 months; P < .001). Acute responders also had a lower risk of developing ascites (P = .001). Chronic responders had a lower probability of bleeding than nonresponders (P < .001). There was a correlation between acute and chronic changes in HVPG (r = 0.62; P = .01).

CONCLUSION

The acute hemodynamic response to beta-blockers can be used to predict the long-term risk of first bleeding. An HVPG reduction > 10% from baseline is the best target to define response in primary prophylaxis.

Authors+Show Affiliations

Gastrointestinal Bleeding Unit, Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Autonomous University, Barcelona, Spain. cvillanueva@santpau.esNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19344721

Citation

Villanueva, Càndid, et al. "Acute Hemodynamic Response to Beta-blockers and Prediction of Long-term Outcome in Primary Prophylaxis of Variceal Bleeding." Gastroenterology, vol. 137, no. 1, 2009, pp. 119-28.
Villanueva C, Aracil C, Colomo A, et al. Acute hemodynamic response to beta-blockers and prediction of long-term outcome in primary prophylaxis of variceal bleeding. Gastroenterology. 2009;137(1):119-28.
Villanueva, C., Aracil, C., Colomo, A., Hernández-Gea, V., López-Balaguer, J. M., Alvarez-Urturi, C., Torras, X., Balanzó, J., & Guarner, C. (2009). Acute hemodynamic response to beta-blockers and prediction of long-term outcome in primary prophylaxis of variceal bleeding. Gastroenterology, 137(1), 119-28. https://doi.org/10.1053/j.gastro.2009.03.048
Villanueva C, et al. Acute Hemodynamic Response to Beta-blockers and Prediction of Long-term Outcome in Primary Prophylaxis of Variceal Bleeding. Gastroenterology. 2009;137(1):119-28. PubMed PMID: 19344721.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acute hemodynamic response to beta-blockers and prediction of long-term outcome in primary prophylaxis of variceal bleeding. AU - Villanueva,Càndid, AU - Aracil,Carles, AU - Colomo,Alan, AU - Hernández-Gea,Virginia, AU - López-Balaguer,Josep M, AU - Alvarez-Urturi,Cristina, AU - Torras,Xavier, AU - Balanzó,Joaquim, AU - Guarner,Carlos, Y1 - 2009/04/01/ PY - 2008/07/19/received PY - 2009/03/05/revised PY - 2009/03/17/accepted PY - 2009/4/7/entrez PY - 2009/4/7/pubmed PY - 2009/7/17/medline SP - 119 EP - 28 JF - Gastroenterology JO - Gastroenterology VL - 137 IS - 1 N2 - BACKGROUND & AIMS: Studies of variceal bleeding have shown that a hemodynamic response to treatment of portal hypertension is appropriate when the hepatic venous pressure gradient (HVPG) decreases below 12 mmHg or by > 20% from baseline. However, in primary prophylaxis, many nonresponders do not bleed and 2 invasive procedures are needed to assess response. We investigated the long-term prognostic value of an acute response to beta-blockers and whether the target reduction in HVPG can be improved in primary prophylaxis. METHODS: An initial hemodynamic study was performed in patients with large varices and without previous bleeding. After baseline measurements were made, propranolol was administered intravenously and measurements were repeated 20 minutes later. Patients were given nadolol daily and a second hemodynamic study was performed. RESULTS: Of 105 patients, 15% had variceal bleeding. Using receiver operating characteristic curve analysis, a decrease of HVPG > or = 10% was the best value to predict bleeding. In the initial study, 75 patients (71%) were responders (HVPG decreased to < or = 12 mmHg or by > or = 10%) and had a lower probability of first bleeding than nonresponders (4% vs 46% at 24 months; P < .001). Acute responders also had a lower risk of developing ascites (P = .001). Chronic responders had a lower probability of bleeding than nonresponders (P < .001). There was a correlation between acute and chronic changes in HVPG (r = 0.62; P = .01). CONCLUSION: The acute hemodynamic response to beta-blockers can be used to predict the long-term risk of first bleeding. An HVPG reduction > 10% from baseline is the best target to define response in primary prophylaxis. SN - 1528-0012 UR - https://www.unboundmedicine.com/medline/citation/19344721/Acute_hemodynamic_response_to_beta_blockers_and_prediction_of_long_term_outcome_in_primary_prophylaxis_of_variceal_bleeding_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5085(09)00509-5 DB - PRIME DP - Unbound Medicine ER -