Einfluß von Molsidomin auf die portale und kardiale Hämodynamik bei Leberzirrhose

Abstract

An investigation was conducted on 21 patients (16 men and five women; mean age 48.2 [34-67] years) with cirrhosis of the liver of various aetiologies to determine whether molsidomine, which selectively reduces pre-load with-out the development of tolerance, effects portal and cardiac haemodynamics in liver cirrhosis and portal hypertension. Intravenous injection of 2 mg molsidomine reduced the hepatic vein closing pressure after 30 min by 8% (P less than 0.05) and the hepatic vein closing pressure gradient by 13.4% (P less than 0.002). The cardiac output fell by 5.8% (P less than 0.02) and the mean systemic arterial pressure by 4.2% (P less than 0.003). The reduction in hepatic venous closing pressure gradient did not correlate with the fall in cardiac output and mean arterial pressure. In 15 of 21 patients the hepatic venous pressure fell, but in six patients (28.6%) the pressure was not reduced (non-responders). The latter failure of response was associated with marked ascites, significant functional liver decompensation and alcoholic liver cirrhosis. Preliminary long-term observations with molsidomine point to a reduction in portal pressure by as much as 40%. This suggests that the drug is suitable for preventing bleeding from oesophageal varices.