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