Non-selective β-blockers improve the correlation of liver stiffness and portal pressure in advanced cirrhosis

Reiberger, Thomas; Ferlitsch, Arnulf; Payer, BA; Pinter, Matthias; Homoncik, Monika; Peck‐Radosavljevic, Markus; Lab, Vienna Hepatic Hemodynamic

doi:10.1007/s00535-011-0517-4

Cited by 101 publications

(63 citation statements)

References 22 publications

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“…LSM has also a good correlation with the stage of cirrhosis, increasing along with HVPG as the Child stage increases [22] . A meta analysis made on 18 studies which included 3644 patients found an overall specificity of 90% (95%CI: 0.81-0.95) and a sensitivity of 79% (95%CI: 0.58-0.91) for LSM by TE in the detection of significant PH [23] .…”

Section: Prediction Of Phmentioning

confidence: 77%

Liver ultrasound elastography: More than staging the disease

Gherlan¹

2015

WJH

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Ultrasound elastography is perhaps the most important breakthrough in the evolution of ultrasonography in the last 15 years. Since transient elastography was introduced, many other methods have been developed and became more and more widely available. The value of ultrasound elastography in staging a chronic liver disease has been established by numerous studies. There have been many studies that have shown that using liver elastography it is possible to predict the presence of the complications of cirrhosis: portal hypertension, presence of esophageal varices (and even their risk of bleeding) and hepatocellular carcinoma. It has been shown that liver elastography can predict the progression of liver fibrosis and also the survival (hepatic events -free) of the patients with chronic liver diseases. These are the real quests of the clinicians, this is the ultimate scope of any medical investigationto predict the outcome of a patient and to help making therapeutic decisions. I brought together only a small amount of the data that has already been written on this subject to support my affirmation that liver ultrasound elastography is more than a tool for staging the liver disease, but it is also comparable to a crystal ball which in the hands of a skilled clinician can reveal the future of the patient and can help to improve this future.

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Section: Prediction Of Phmentioning

confidence: 77%

Liver ultrasound elastography: More than staging the disease

Gherlan¹

2015

WJH

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“…The most important are related to technical failure in patients with obesity, and to falsely high results due to conditions unrelated to liver fibrosis (hepatic inflammation, extrahepatic cholestasis, cardiac congestion and meal ingestion [30,31]). While increases in LS over time increase the risk of clinical events in patients with cirrhosis [34], this technique cannot be used to monitor changes in HVPG occurring during treatment with β-blockers for portal hypertension [35]. …”

Section: Introductionmentioning

confidence: 99%

Clinical Evaluation and Prognosis

Hernández‐Gea¹,

Berzigotti²

2015

Dig Dis

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Background: Liver cirrhosis is no longer considered a homogeneous disease, with two different phases now identified: ‘compensated' and ‘decompensated' cirrhosis, in which complications of cirrhosis characterize the latter. Within each phase, different stages and predictors should be recognized in order to correctly stratify the prognosis and individualize possible therapeutic options. Key Messages: In compensated cirrhosis the presence of clinically significant portal hypertension [CSPH = hepatic venous pressure gradient (HVPG) ≥10 mm Hg] constitutes the most important independent predictor of several relevant clinical endpoints (formation of esophageal varices; first clinical decompensation). An optimal HVPG response to medical therapy of portal hypertension (HVPG reduction <12 mm Hg or ≥20% vs. the pretreatment value, responders) has been consistently linked to a decrease in the risk of variceal bleeding both in primary and secondary prophylaxis, and to a decrease in the risk of presenting other clinical decompensating events. Furthermore, in patients undergoing secondary prophylaxis of variceal bleeding, being an HVPG responder is associated with an improved survival. HVPG also maintains an independent prognostic value in patients with decompensated cirrhosis. Noninvasive alternatives to HVPG for the prediction of CSPH have been investigated; liver stiffness by transient elastography and the combination of liver stiffness, spleen size by ultrasound and platelet count are currently the best methods to noninvasively diagnose CSPH, with an accuracy of about 90%. Additional factors modulate prognosis in cirrhosis. Liver function (albumin, bilirubin, INR) is independently associated with prognosis both in compensated and decompensated cirrhosis, and in the latter phase renal function also plays a central role. Among clinical cofactors, obesity and diabetes are emerging as variables increasing the risk of progression to decompensation and death in cirrhosis. Conclusions: Prognostic stratification in patients with cirrhosis should take into account a complex interplay of several clinical, hemodynamic and biological variables. The present review summarizes the existing evidence regarding prognostic factors in cirrhosis, with particular emphasis on compensated cirrhosis.

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“…They explained this by the fact that mechanisms of PHT become less dependent on the intra-hepatic vascular resistance caused by accumulation of fibrous tissue (as reflected by an increase in LS) above a degree of HPVG, while complex hemodynamic changes (e.g. hyper-dynamic circulation and splanchnic vasodilatation) contribute to the increase in portal pressure that are not assessed by the means of LS (20,23). Accordingly, at higher HPVG levels (where larger OV and hemorrhage risk increases), LS may not be an ideal non-invasive surrogate of HVPG, and, thus, its direct consequence OVs.…”

mentioning

confidence: 99%

“…Even though good correlations have been reported between LS and CSPH, LS measurements may not be good enough at predicting high-risk OVs. Two studies (20,23) stated important findings on the relationship between LS and CSPH, to explain this contradiction. Strong correlation coefficient existed between LS by TE and HVPG values < 12 mmHg, while correlation coefficient dropped to a suboptimal level for HPVG values of ≥ 12 mmHg, which is the threshold for variceal formation and hemorrhage (20,23).…”

mentioning

confidence: 99%

“…Two studies (20,23) stated important findings on the relationship between LS and CSPH, to explain this contradiction. Strong correlation coefficient existed between LS by TE and HVPG values < 12 mmHg, while correlation coefficient dropped to a suboptimal level for HPVG values of ≥ 12 mmHg, which is the threshold for variceal formation and hemorrhage (20,23). They explained this by the fact that mechanisms of PHT become less dependent on the intra-hepatic vascular resistance caused by accumulation of fibrous tissue (as reflected by an increase in LS) above a degree of HPVG, while complex hemodynamic changes (e.g.…”

mentioning

confidence: 99%

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Platelet Count/Spleen Diameter Ratio and Shear-Wave Elastography for Non-Invasive Prediction of High-Risk Varices: Can We Delay Screening Endoscopy for Compensated Cirrhosis?

et al. 2017

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Background: Periodic Upper Gastrointestinal Endoscopy (UGIE) for Oesophageal Varices (OVs) is recommended in all compensated cirrhotic patients. The prevalence of early stage cirrhosis is on the rise with the contribution of non-invasive models for liver fibrosis. The healthcare system needs to focus on cost-effective surveillance strategies re-channelling its efforts for high-risk OVs. This study evaluated whether non-invasive means for prediction of high-risk OVs could limit UGIEs among the the Child-Pugh class A cirrhosis population. Materials and Methods: Endoscopic, clinical, and laboratory data were retrieved from medical records. Shear-Wave Elastography (SWE) and ultrasound spleen measurements, Platelet Count/Spleen Diameter (PC/SD) ratio and Child-Pugh score calculations were performed. Results: Successful elasticity acquisitions were performed in 99 cirrhosis patients. Child-Pugh score was A in 67.2% cases. The PC/SD

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Non-selective β-blockers improve the correlation of liver stiffness and portal pressure in advanced cirrhosis

Abstract: Targeting the hyperdynamic circulation and the increased splanchnic blood inflow by treatment with NSBB unmasks the linear (mechanical) correlation of HVPG and LS in patients with HVPG > 12 mmHg. Measurement of LS by TE is not a feasible method to assess the dynamic components of PHT.

Cited by 101 publications

References 22 publications

Liver ultrasound elastography: More than staging the disease

Liver ultrasound elastography: More than staging the disease

Clinical Evaluation and Prognosis

Platelet Count/Spleen Diameter Ratio and Shear-Wave Elastography for Non-Invasive Prediction of High-Risk Varices: Can We Delay Screening Endoscopy for Compensated Cirrhosis?

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