Related Experiment Videos
Beta-blockade with propranolol and hepatic artery blood flow in patients with cirrhosis
1Liver Unit, Hospital Clínic i Provincial, University of Barcelona, Spain.
Insights
Propranolol reduces hepatic artery blood flow in cirrhosis patients, but to a lesser extent than cardiac output. This increases the proportion of cardiac output directed to the liver.
Area of Science:
- Cardiology
- Hepatology
- Pharmacology
Background:
- Cirrhosis and portal hypertension significantly impact hemodynamics.
- Propranolol is used to manage complications but its effect on hepatic artery blood flow is unclear.
Purpose of the Study:
- To investigate the effects of propranolol on hepatic artery blood flow in cirrhotic patients with a portacaval shunt.
Main Methods:
- Measured hepatic artery blood flow, cardiac output, heart rate, and mean arterial pressure before and after propranolol infusion in 12 patients.
- Utilized indocyanine green for hepatic artery flow and thermal dilution for cardiac output.
Main Results:
- Propranolol significantly reduced cardiac output and heart rate, and increased systemic vascular resistance.
- Hepatic artery blood flow was significantly reduced, but less so than cardiac output.
- The fraction of cardiac output delivered to the liver increased significantly after propranolol administration.
Conclusions:
- Propranolol decreases hepatic artery blood flow in cirrhotic patients with portacaval shunts.
- The relative reduction in hepatic artery blood flow is less than the reduction in cardiac output.
- Propranolol may favorably alter hepatic perfusion in this patient group.
Abstract:
In patients with cirrhosis and portal hypertension, propranolol administration reduces heart rate and cardiac output and diminishes portal pressure and collateral blood flow. However, there is little information on the possible effects of propranolol on hepatic artery blood flow. The present study addressed this question in 12 cirrhotic patients with end-to-side portacaval shunt, in whom all of the liver blood flow represents the hepatic artery blood flow. Hepatic artery blood flow (continuous infusion of indocyanine green), cardiac output (thermal dilution), heart rate and mean arterial pressure were measured before and 20 min after the intravenous infusion of 10 to 15 mg of propranolol. beta-Adrenergic blockade caused a significant reduction of cardiac output (from 9.1 +/- 2.1 to 7.1 +/- 1.4 liters per min, p less than 0.001) (mean +/- S.D.) and heart rate (from 85 +/- 10 to 71 +/- 7 beats per min, p less than 0.001), and a significant increase of systemic vascular resistance (from 9.0 +/- 2.1 to 11.7 +/- 2.7 mmHg per liter per min, p less than 0.001), whereas mean arterial pressure did not change (77 vs. 78 mmHg). Propranolol significantly reduced hepatic artery blood flow (from 0.65 +/- 0.20 to 0.55 +/- 0.14 liters per min, p less than 0.01). However, reduction of hepatic artery blood flow (-12.9 +/- 7.3%) was significantly less than reduction of cardiac output (-21.1 +/- 5.2%, p less than 0.01). As a result, the fraction of the cardiac output delivered to the liver was significantly greater after propranolol (8.0 +/- 1.7%) than before (7.3 +/- 1.7%, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)