Total effective vascular compliance in patients with cirrhosis. Effects of propranolol

Abstract

Background : Total effective vascular compliance (TEVC), may be increased in cirrhosis. However, its significance is unclear. Aims : To investigate TEVC in patients with cirrhosis, and the effects of propranolol. Methods : Seven patients without liver disease and 44 cirrhotic patients were studied before and after double-blind administration of propranolol ( n=33 ) or placebo ( n=11 ). Measurements: TEVC (right atrial pressure response to rapid central volume expansion), hepatic venous pressure gradient (HVPG) and systemic hemodynamics. Results : TEVC (ml mmHg −1 kg −1) was increased in cirrhotics (1.67±0.66 versus 1.33±0.32 in controls; P<0.05 ). TEVC was not modified by placebo, but was markedly reduced by propranolol (from 1.74±0.75 to 1.33±0.56; P<0.01 ). Propranolol decreased HVPG >10% in 20 patients (‘responders’: −20±9%) but <10% in 13 ‘non-responders’. TEVC was normalized by propranolol in HVPG ‘responders’ (from 1.76±0.88 to 1.21±0.51; P<0.01 ), but not in ‘non-responders’ (1.69±0.48 to 1.52±0.59; NS). Reduction of TEVC in responders was accompanied by increased free hepatic vein pressure (+21±20%, P=0.05 ; ∼60% of the fall in HVPG), which was not observed in non-responders (+3±11%, NS). Conclusions : TEVC is increased in cirrhosis. This abnormality is corrected by propranolol in patients exhibiting a >10% fall in HVPG, suggesting that changes in vascular compliance may influence the portal pressure response to propranolol.