Duplex Doppler ultrasonography allows a multiorgan noninvasive approach to splanchnic pharmacodynamics in patients with cirrhosis

Abstract

Duplex Doppler ultrasonography (DDU) is a suitable method to evaluate acute splanchnic hemodynamic effects of vasoactive drugs. It allows the contemporary evaluation of arterial and venous splanchnic parameters. Forty-six cirrhotic patients with esophageal varices were investigated by DDU. Portal blood flow mean velocity (PBV) (cm/s), portal blood flow volume (PBF) (ml/min), pulsatility index (PI) [(maximum-minimum)/mean velocity] in the superior mesenteric artery, in intrahepatic arteries (main branches), in an instrasplenic artery, and in interlobar arteries of the kidneys were measured before and 120-180 min after the administration of nadolol (80 mg p.o.) in 24 patients, and before and 120 min after placebo administration in 9 patients. In 13 patients who were chronically treated with nadolol, DDU parameters were evaluated before and 90 min after the administration of isosorbide-5-mononitrate (20 mg p.o.).

Results: placebo caused no hemodynamic change. After nadolol, heart rate decreased (-22 +/- 8%), and so did PBV and PBF (8.8 +/- 3.4 vs. 10.9 +/- 3.2, -20 +/- 17%, p < 0.0001; 660 +/- 347 vs. 852 +/- 371, -24 +/- 18%, p < 0.0001). Mesenteric PI increased (2.72 +/- 0.67 vs. 2.28 +/- 0.56, +21 +/- 25%, p = 0.005). Hepatic, splenic, and renal PIs showed slight, not significant changes (1.42 +/- 0.41 vs. 1.38 +/- 0.32, p = NS; 1.05 +/- 0.23 vs. 0.99 +/- 0.21, p = NS; 1.24 +/- 0.26 vs. 1.19 +/- 0.20, p = NS, respectively). After the administration of isosorbide-5-mononitrate, PBV decreased (8.2 +/- 2.0 vs. 9.4 +/- 2.3, -12 +/- 13%, p = 0.006), while PBF did not modify (648 +/- 189 vs. 711 +/- 209, p = NS).(ABSTRACT TRUNCATED AT 250 WORDS)