Estimating effect of terlipressin on portal pressure in cirrhosis by observing hepatic vein Doppler waveform

Abstract

Objective: To observe the changes in Doppler waveform of hepatic vein after the administration of terlipressin, and to assess indirectly the efficacy of the drug to reduce the Hepatic Vein Pressure Gradient and portal pressure.

Methods: The quasi-experimental study was conducted at the Jinnah Postgraduate Medical Centre, Karachi, from April 1 to November 25, 2011, and comprised 50 patients with cirrhosis with abnormal Doppler waveform of the hepatic vein. Patients with diseases causing abnormal hepatic vein doppler waveform were excluded. Doppler waveforms were studied for 20 minutes before and for 20 minutes after the administration of terlipressin. Tracings with best waveform before and after injection were saved for analysis. Changes in waveform after vasoactive drug were defined as mild, significant, marked and gross changes. SPSS 10 was used for statistical analysis.

Results: Of the 50 patients, 36 (72%) were males and 14 (28%) females. Commonest waveform was monophasic 38 (76%). Gross changes i.e. turning triphasic from monophasic waveform was observed in 8 (16%) patients. Significant gross changes were seen in 24 (48%) patients. Total number of patients showing improvement in waveform was 36 (72%). In no case, waveform deteriorated after the administration of terlipressin (p = 0.001).

Conclusion: Non-invasive method of observing the improvement of hepatic vein waveform by duplex ultrasound, after more studies, may be an important tool for assessing and monitoring the effects of portal pressure lowering drugs.