Changes in Doppler Ultrasound Indices of Hepatic Circulation after Treatment with Beta Blockers: A Pilot Study

Adnan Salim; Muhammad Israr- ul-Haq; Masood Javed; Faisal Ehsan Cheema; Mubashir Ijaz; Karna Rajbanshi; Aamir Khan; Arshad Kamal Butt; Altaf Alam

doi:10.29054/apmc/2016.273

Adnan Salim Senior Registrar, Gastroenterology Shaikh Zayed Hospital, Lahore
Muhammad Israr- ul-Haq Trainee Registrar, Gastroenterology Shaikh Zayad Hospital, Lahore
Masood Javed Associate Professor, Medicine PMC/Allied Hospital, Faisalabad
Faisal Ehsan Cheema PMO Pinum Hospital, Faisalabad
Mubashir Ijaz Consultant Radiologist, Radiology Shaikh Zayad Hospital, Lahore
Karna Rajbanshi Trainee Registrar, Gastroenterology Shaikh Zayad Hospital, Lahore
Aamir Khan Consultant Radiologist, Radiology Shaikh Zayad Hospital, Lahore
Arshad Kamal Butt Professor of Gastroenterology Shaikh Zayad Hospital, Lahore
Altaf Alam Professor of Gastroenterology Shaikh Zayad Hospital, Lahore

DOI: https://doi.org/10.29054/apmc/2016.273

Keywords: Portal hypertension, Doppler ultrasound parameters, Beta-blockers, Carvedilol, Non-invasive assessment of portal hypertension

Abstract

Background: Portal hypertension is a serious complication of liver cirrhosis. Doppler ultrasound assessment may be a non-invasive and cost-effective means of evaluating portal hemodynamics in patients with portal hypertension. Aims & objectives: To assess efficacy of Doppler ultrasound in detecting changes in hemodynamics of hepatic circulation after beta-blocker administration. Methodology: 11 patients with liver cirrhosis and portal hypertension were included. All underwent Doppler assessment of portal vein velocity (PVV), spleno-portal index (SPI), congestive index (CI), liver vascular index (LVI), dampening index (DI), hepatic artery velocity (HAV), splenic artery velocity (SAV), hepatic artery resistive index (HARI) and splenic artery resistive index (SARI). They were started on beta-blocker carvedilol 6.25 mg once daily and recalled after two weeks for repeat assessment. Results: Out of 13 enrolled, 4 were lost to follow up and one stopped carvedilol. 8 remained. The changes in parameters were: PVV: reduction in 3 (37.5%), no change in 1 and increase in 4(50%) patients; SPI: reduction in 3 (37.5%) and increase in 5 (62.5%); CI: reduction in 3 (37.5%), no change in 1 and increase in 4 (50%); LVI: decrease in 3 (50%), no change in 1 and increase in 2; DI: decrease in 5 (62.5%) and increase in 3 (37.5%); HAV: increase in 4 (50%), no change in 1 (12.5%) and decrease in 3 (37.5%); SAV: decrease in 4 (50%) & increase in 4 (50%); HARI: increase in 7 (87.5%) and decrease in 1 (12.5%); SARI: reduction in 3 (37.5%) and increase in 3 (37.5%). 3 patients achieved reduction in 5 (PVV, LVI, DI, SARI & SAV) parameters. DI had the largest number of patients with observable reduction and HARI with the largest number showing observable increase in measured parameters. Conclusion: Doppler ultrasound represents a cost effective means of assessing the hemodynamics of hepatic circulation and any associated changes due to diseases and drugs.