Total effective vascular compliance in patients with cirrhosis.: Effects of propranolol

Background: Total effective vascular compliance (TEVC), may be increased in cirrhosis. However, its significance is unclear. Aims: To investigate TEVC in patients with cirrhosis, and the effects of propranolol. Methods: Seven patients without liver disease and 44 cirrhotic patients were studied before and after double-blind administration of propranolol (n = 33) or placebo (n = 11). Measurements: TEVC (right atrial pressure response to rapid central volume expansion), hepatic venous pressure gradient (HVPG) and systemic hemodynamics. Results: TEVC (ml mmHg(-1) kg(-1)) was increased in cirrhotics (1.67 +/- 0.66 versus 1.33 +/- 0.32 in controls; P < 0.05). TEVC was not modified by placebo, but was markedly reduced by propranolol (from 1.74 +/- 0.75 to 1.33 +/- 0.56; P < 0.01). Propranolol decreased HVPG >10% in 20 patients ('responders': -20 +/- 9%) but <10% in 13 'nonresponders'. TEVC was normalized by propranolol in HVPG 'responders' (from 1.76 +/- 0.88 to 1.21 +/- 0.51; P < 0.01), but not in 'non-responders' (1.69 +/- 0.48 to 1.52 +/- 0.59; NS). Reduction of TEVC in responders was accompanied by increased free hepatic vein pressure (+21 +/- 20%, P = 0.05; similar to60% of the fall in HVPG), which was not observed in non-responders (+3 +/- 11%, NS). Conclusions: TEVC is increased in cirrhosis. This abnormality is corrected by propranolol in patients exhibiting a >10% fall in HVPG, suggesting that changes in vascular compliance may influence the portal pressure response to propranolol. (C) 2002 European Association for the Study of the Liver. Published by Elsevier Science B.V. All rights reserved.