Systemic and regional hemodynamic effects of isosorbide dinitrate in patients with liver cirrhosis and portal hypertension

Abstract

In a group of 17 cirrhotic patients with portal hypertension, we have investigated the effects of 5 mg sublingual administration of isosorbide dinitrate (IDN) on central hemodynamics, on regional (hepatic and renal) hemodynamics and on blood gases. Fifteen min after drug administration, we observed a decrease in the right atrial mean pressure from 4 ± 1 to 3 ± 1 mmHg (mean ± S.E.M., dP < 0.02) and of pulmonary arterial wedge pressure from 7 ± 1 to 4 ± 1 mmHg ( P < 0.001) with decreases of the cardiac index from 4.2 ± 0.2 to 3.7 ± 0.2 l/min/m 2 ( P < 0.001) and the mean arterial pressure from 89 ± 4 to 72 ± 3 mmHg ( P < 0.001) and an increase in heart rate from 86 ± 4 to 94 ± 5 beats/min ( P < 0.001). Arterial P O 2 decreased from 73 ± 2 to 66 ± 2 mmHg ( P < 0.001). As a consequence of both cardiac index and arterial P O 2 reductions, O 2 transport to the tissues was reduced from 602 ± 32 to 518 ± 26 ml/min · m 2 ( P < 0.001). The hepatic venous pressure gradient decreased from 17 ± 1 to 14 ± 1 mmHg ( P < 0.001) and hepatic vein P O 2 did not change. The hepatic blood flow (HBF) determined in 7 patients remained unchanged. Renal blood flow (RBF) determined in 5 patients decreased from 0.76 ± 0.11 to 0.68 ± 0.11 l/min ( P < 0.001). In conclusion, isosorbide dinitrate reduces portal hypertension in patients with liver cirrhosis without compromising hepatic perfusion. This effect, however, is associated with a decrease in O 2 delivery and a slight reduction in renal perfusion.