Summary
In the past decade several randomized trials have shown a beneficial effect of propranolol in cirrhotic patients. The effect of propranolol has been attributed to a reduction in portal vein pressure. So far the monitoring of portal vein hemodynamics following propranolol administration has been achieved mainly by hepatic vein catheterization. We studied the effect of propranolol on portal vein hemodynamics noninvasively in five healthy volunteers using duplex sonography and indocyanine green clearance. Measured by duplex sonography, blood flow was reduced by 28.6% in the portal vein (P<0.05) and by 8.7% in the hepatic artery (NS) 60 min after oral administration of 80 mg propranolol. During this time total hepatic blood flow, measured by indocyanine green clearance, was reduced by 19.5% (P<0.05). We conclude that both methods are useful for the study of portal vein hemodynamics during propranolol therapy, duplex sonography being more easily practicable.
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Abbreviations
- ICG:
-
ocyanine green
References
Banaszak EF, Stekiel RA, Grace RA, Smith JJ (1960) Estimation of hepatic blood flow using a single-injection dye clearance method. Am J Physiol 198:877–880
Bosch J, Mastai R, Kravetz D (1984) Effects of propranolol on azygos venous blood flow and hepatic and systemic hemodynamics in cirrhosis. Hepatology 4:1200–1205
Burczynski FJ, Pushka KL, Sitar DS, Greenway CV (1987) Hepatic plasma flow: accuracy of estimation from bolus injections of indocyanine green. Am J Physiol 252:H953-H962
Burns E, Ball CE, Christie JP, Broadhead GD, Tucker GT, Bax NDS (1989) Direct and indirect measurement of the hepatic extraction ratio of indocyanine green in the rat. Clin Sci 76:503–508
Charlisle KM, Halliwell M, Read AE, Wells PNT (1992) Estimation of total hepatic blood flow by duplex ultrasound. Gut 33:92–97
Evans DH, McDicken WN, Skidmore R, Woodcock JP (1989) Volumetric blood flow measurements. In: Evans DH (ed) Doppler ultrasound. Physics, instrumentation, and clinical applications. Wiley, New York, pp 188–205
Feeley J, Guy E (1982) Ranitidine also reduces liver blood flow. Lancet 1:169
Garcia-Tsao G, Grace ND, Groszmann RJ, Conn HO, Bermann MM, Patrick MJC, Morse SS, Alberts JL (1986) Short-term effects of propranolol on portal venous pressure. Hepatology 6:101–106
Gill RW (1985) Measurement of blood flow by ultrasound: accuracy and sources of error. Ultrasound Med Biol 11:625–641
Grainger SL, Keeling PWN, Brown IMH, Marigold JH, Thompson RPH (1983) Clearance and non-invasive determination of the hepatic extraction of indocyanine green in baboons and man. Clin Sci 64:207–212
Groszmann RJ, Atterbury CE (1982) The pathophysiology of portal hypertension: a basis for classification. Semin Liver Dis 2:117–186
Groszmann RJ, Bosch J, Grace ND, Conn HO, Garcia-Tsao G, Navasa M, Alberts J, Rodes J, Fischer R, Bermann M, Rofe S, Patrick M, Lerner E (1990) Hemodynamic events in a prospective randomized trial of propranolol versus placebo in the prevention of a first variceal hemorrhage. Gastroenterology 99:1401–1407
Hayes PC, Davis JM, Lewis JA, Bouchier IA (1990) Meta-analysis of value of propranolol in prevention of variceal haemorrhage. Lancet 336:153–156
Hunton DB, Bollman JL, Hoffman HN (1960) Studies of hepatic function with indocyanine green. Gastroenterology 39:713–724
Koslin DB, Berland L (1987) Duplex Doppler examination of the liver and portal venous system. J Clin Ultrasound 15:675–686
Kroeger RJ, Groszmann RJ (1985) Increased portal venous resistance hinders portal pressure reduction during the administration of ß-adrenergic blocking agents in a portal hypertensive model. Hepatology 5:97–101
Lebrec D, Hillon P, Munoz C, Goldfarb G, Nouel O, Benhamou JP (1982) The effect of propranolol on portal hypertension in patients with cirrhosis: a hemodynamic study. Hepatology 2:523–527
Moriyasu F, Ban N, Nishida O, Nakamura T, Miyake T, Uchino H, Kanematzu Y, Koizumi S (1986) Clinical application of an ultrasonic duplex system in the quantitative measurement of portal blood flow. J Clin Ultrasound 14:579–588
Moriyasu F, Nishida O, Ban N (1986) Measurement of portal vascular resistance in patients with portal hypertension. Gastroenterology 90:707–710
Nakayama T, Hiyama Y, Ohnishi K (1983) Arterioportal shunts on dynamic computed tomography. Am J Radiology 140:953–957
Ohnishi K, Nakayama T, Saito M (1985) Effects of propranolol on portal hemodynamics in patients with chronic liver disease. Am J Gastroenterol 80:132–135
Ohnishi K, Saito M, Koen H, Nakayama T, Nomura F, Okuda K (1985) Pulsed Doppler flow as a criterion of portal venous velocity: comparison with cineangiographic measurements. Radiology 154:495–498
Rector WG Jr (1985) Propranolol for portal hypertension. Arch Intern Med 145:648–650
Takayasu K, Takashi M, Musha H (1982) Spontaneous reversal of portal blood flow demonstrated by percutaneous transhepatic catheterization: report of two cases. Gastroenterology 82:753–757
Valle D, Bercoff E, Menu Y (1984) Discrepancy between wedged hepatic venous pressure and portal venous pressure after acute propranolol administration in patients with alcoholic cirrhosis. Gastroenterology 86:1400–1403
Zoller WG, Wierscher C, Wagner DR (1993) Signal processors in duplex sonography: in vitro comparison between analog and digital methods. Res Exp Med 193:105–115
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Zoller, W.G., Wagner, D.R. & Zentner, J. Effect of propranolol on portal vein hemodynamics: assessment by duplex sonography and indocyanine green clearance in healthy volunteers. Clin Investig 71, 654–658 (1993). https://doi.org/10.1007/BF00184496
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DOI: https://doi.org/10.1007/BF00184496