Non-selective beta-blockers impair global circulatory homeostasis and renal function in cirrhotic patients with refractory ascites

Téllez, Luís; Ibáñez‐Samaniego, Luis; Villar, Candelas Pérez del; Yotti, Raquel; Martínez, Javier; Carrión, L.; Santiago, Enrique Rodríguez de; Rivera, Maite; González‐Mansilla, Ana; Pastor, Óscar; Bermejo, Javier; Bañares, Rafael; Albillos, Agustı́n

doi:10.1016/j.jhep.2020.05.011

Cited by 80 publications

(86 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In conclusion, we believe that Téllez et al 1 have beautifully described the hemodynamic and LV systolic function alterations in patients with ascites after NSBB therapy. The feasibility of measuring EIVPD across various settings in patients with cirrhosis and ascites, as well as its long-term prognostic significance, mandates further research.…”

mentioning

confidence: 55%

“…We thank Dr Mehtani and colleagues for their interest in our article. 1 Dr Mehtani et al express some concern about the purported relationship between diastolic dysfunction and renal impairment in response to the use of non-selective betablockers (NSBBs), and whether this could have been better addressed by conventional echocardiography. We observed that NSBBs impaired diastolic function in our refractory ascites but not diuretic-responsive ascites group, as shown by the significant increases in E/A and E/e' recorded in the former.…”

Section: Financial Supportmentioning

confidence: 99%

“…These results are in keeping with those of Turco et al, indicating that as cirrhosis progresses into the decompensated stage and peripheral vasodilation worsens, cardiac compensatory mechanisms are exhausted and unable to further step up to maintain perfusion pressure in refractory ascites. 1,2 Dr Mehtani et al were surprised by the rather low dose of propranolol needed to achieve beta-blockade and a hepatic venous pressure gradient (HVPG) response in both groups. It is important to emphasize that we individually titrated the dose of propranolol following current recommendations, which include a target reduction in heart rate up to the maximum tolerated dose and a systolic arterial pressure <90 mmHg.…”

Section: Financial Supportmentioning

confidence: 99%

“…We read with great interest the study by Tellez et al 1 highlighting mechanisms of hemodynamic alterations and associated renal dysfunction with the use of a 4-week nonselective beta-blocker (NSBB) therapy in refractory ascites (RA) and diuretic responsive ascites (DRA). 1 They proposed ejection intra-ventricular pressure difference (EIVPD) as a novel loadindependent measure that predicts LV systolic function decline better than standard load-dependent measures (ejection fraction and stroke volume). The authors demonstrated a greater reduction in cardiac output, EIVPD, and renal perfusion pressure among patients with RA compared to patients with DRA, which resulted in greater renal dysfunction in the RA group.…”

mentioning

confidence: 99%

“…Secondly, although the baseline disease severity (Child-Pugh and model for end-stage liver disease score) was higher in patients with RA than DRA, 1 it was interesting to note the similar values of hepatic venous pressure gradient (HVPG) and heart rate between the 2 groups. Previous studies 4,5 had described higher HVPG and heart rate in patients with more severe disease, which could be due to greater severity of portal hypertension and a compensatory increase in heart rate.…”

mentioning

confidence: 99%

See 4 more Smart Citations

Beta-blockers in refractory ascites – is it truly the end of the road?

Mehtani

Roy

Verma

et al. 2020

Journal of Hepatology

View full text Add to dashboard Cite

mentioning

confidence: 55%

Section: Financial Supportmentioning

confidence: 99%

Section: Financial Supportmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Beta-blockers in refractory ascites – is it truly the end of the road?

Mehtani

Roy

Verma

et al. 2020

Journal of Hepatology

View full text Add to dashboard Cite

Nonselective Beta‐Blockers in Portal Hypertension: Why, When, and How?

Rabiee

García–Tsao

Tapper

2022

Clinical Liver Disease

View full text Add to dashboard Cite

show abstract

Molecular Profiling of Decompensated Cirrhosis by a Novel MicroRNA Signature

Paredes

Manicardi²,

Téllez

et al. 2021

Hepatology Communications

Self Cite

View full text Add to dashboard Cite

Noninvasive staging of decompensated cirrhosis is an unmet clinical need. The aims of this study were to characterize and validate a novel microRNA (miRNA) signature to stage decompensated cirrhosis and predict the portal pressure and systolic cardiac response to nonselective beta-blockers (NSBBs). Serum samples from patients with decompensated cirrhosis (n = 36) and healthy controls (n = 36) were tested for a novel signature of five miRNAs (miR-452-5p, miR-429, miR-885-5p, miR-181b-5p, and miR-122-5p) identified in the secretome of primary human hepatocytes and for three miRNAs (miR-192-5p, miR-34a-5p, and miR-29a-5p) previously discovered as biomarkers of chronic liver disease. All patients had ascites, which was refractory in 18 (50%), and were placed on NSBBs for variceal bleeding prophylaxis. In all patients, serum miRNAs, hepatic venous pressure gradient, and an echocardiogram study were performed before and 1 month after NSBBs. Patients with cirrhosis had lower serum levels of miR-429, miR-885-5p, miR-181b-5p, miR-122-5p, miR-192-5p, and miR-29a-5p (P < 0.05). Baseline serum miR-452-5p and miR-429 levels were lower in NSBB responders (P = 0.006). miR-181b-5p levels were greater in refractory ascites than in diuretic-sensitive ascites (P = 0.008) and correlated with serum creatinine. miR-452-5p and miR-885-5p were inversely correlated with baseline systemic vascular resistance (ρ = −0.46, P = 0.007; and ρ = −0.41, P = 0.01, respectively) and with diminished systolic contractility (ρ = −0.55, P = 0.02; and ρ = −0.55, P = 0.02, respectively) in patients with refractory ascites after NSBBs. Conclusion: Analysis of a miRNA signature in serum discriminates between patients with decompensated cirrhosis who show more severe systemic circulatory dysfunction and compromised systolic function after beta-blockade and those more likely to benefit from NSBBs. (Hepatology Communications 2021;5:309-322). M icroRNAs (miRNAs) are small noncoding RNA molecules (18-25 nucleotides) involved in the posttranscriptional regulation of protein-coding genes controlling many cellular processes. (1) In serum, miRNAs may be bound to circulating proteins or, more frequently, contained within extracellular vesicles (EVs). (2) EVs are nanometric double-membrane structures that envelop miR-NAs and shuttle this biological information from one cell type to another. Because their cargo dynamically

show abstract

Non-selective beta-blockers impair global circulatory homeostasis and renal function in cirrhotic patients with refractory ascites

Cited by 80 publications

References 33 publications

Beta-blockers in refractory ascites – is it truly the end of the road?

Beta-blockers in refractory ascites – is it truly the end of the road?

Nonselective Beta‐Blockers in Portal Hypertension: Why, When, and How?

Molecular Profiling of Decompensated Cirrhosis by a Novel MicroRNA Signature

Contact Info

Product

Resources

About