“Acute versus chronic hemodynamic response of Carvedilol in Chronic Liver Disease with Portal hypertension”

Abstract

Background: Hemodynamic studies give objective method to measure the response but need to be repeated during the course of therapy. Data comparing acute with chronic hemodynamic response of Carvedilol is scarce and needs to be studied further to elucidate the course and predictors of response, so the single hemodynamic study envisages the long-term response. Aims and Objectives: The purpose of this study was 1.To assess and compare the acute and chronic hemodynamic response to Carvedilol along with their predictors in Cirrhotic patients.2.To evaluate if acute response is maintained long term. Methods: In one hundred two consecutive patients of chronic liver disease with esophageal varices, Hepatic Venous Pressure Gradient (HVPG) was measured at baseline and 90 minutes after initial administration of 12.5 mg of Carvedilol to assess the acute response. These patients were reassessed at 3 months of dose optimization for chronic response. The acute responders were compared with chronic responders. Results: Acute response was seen in 51% and chronic in 62% patients. Most of the patients who responded to optimized therapy after no acute response belonged to CTP A. Mean reduction of HVPG in responders was 4.5± 2.2 mmHg to loading dose and 5. 5± 1.7 mmHg at 3 months. Low Cardiac output (CO), more than 2.5 mmHg drop acutely and dose optimization were independent predictors of response for acute, chronic and chronic response with no acute response respectively. Conclusion: Acute response assessed by hemodynamic study at initiation of treatment is important predictor of chronic response and is maintained over period of time. Dose optimization to achieve response is more appropriate for CTP A then B and C.