Noninvasive measurement of femoral blood flow and portal pressure response to propranolol in patients with cirrhosis

Abstract

This study investigated the correlation between changes in hepatic and systemic hemodynamics and femoral blood flow (FBF), measured by dual-beam pulsed wave Doppler, in 58 portal hypertensive patients receiving propranolol (0.15 mg/Kg intravenously; n = 44) or placebo (n = 14) under double-blind conditions. Placebo administration had no effects. Propranolol caused significant reductions ( P < .0001) in hepatic venous pressure gradient (HVPG; from 19.1 ± 4.1 to 16.2 ± 4.2 mm Hg), azygos blood flow (from 563 ± 204 to 387 ± 176 mL/ min), cardiac index (CI; from 4.4 ± 1.0 to 3.3 ± 0.8 L/m 2/min), and FBF (from 237 ± 79 to 176 ± 58 mL/m 2/min). In 17 patients HVPG decreased below 12 mm Hg and/or more than 20% of the baseline value (good response; mean change, −26 ± 8%); in the remaining 27 patients (poor response) the mean change in HVPG was less: −9 ± 6%. Patients with a good response had bled less often from varices, had significantly higher FBF (272 ± 73 vs. 215 ± 76 mL/m 2/min) and lower baseline HVPG (16.8 ± 3.9 vs. 20.6 ± 3.6 mm Hg) than those with poor response in HVPG. The good response was also associated with greater decreases in FBF (−33 ± 12 vs. −19 ± 13% in poor responders), CI (−30 ± 9 vs. −19 ± 12%), and heart rate (−19 ± 5 vs. −16 ± 6%). A decrease in FBF of >20% predicted a good response in 16 of 28 patients (positive predictive value, 57%). A negative test (decrease in femoral blood flow of <20%) predicted a lack of response in HVPG in 15 of 16 patients (negative predictive value, 94%). This study suggests that the noninvasive measurements of FBF allow the identification of patients with a poor response of HVPG to propranolol. However, measurements of HVPG would still be needed for patients whose FBF decreased >20%, half of whom have an insufficient decrease in HVPG.