Primary prophylaxis with nadolol in cirrhotic patients: Doppler patterns of splanchnic hemodynamics in good and poor responders

Background/Aims We aimed to characterize by echo-color-Doppler the splanchnic hemodynamics of patients good and poor responders to primary prophylaxis with nadolol. Methods Thirty cirrhotic patients (Child-score 7.0±1.8) with medium/large esophageal varices without previous bleedings were consecutively enrolled. At inclusion and after 3 months of treatment with nadolol, they underwent a splanchnic echo-color-Doppler study and a measurement of hepatic venous pressure gradient (HVPG). Results Nadolol (60±36 mg/day; range 20–160) induced a significant reduction of HVPG (16.6±6.1 vs. 19.4±4.6 mmHg, P<0.0001). 13 patients (43.3%) were hemodynamic responders. Responders and Poor-responders had similar baseline clinical characteristics. Poor-responders at baseline were characterized by lower impedance indexes in superior mesenteric artery (SMA) (PI 2.29±0.45 vs. 2.74±0.46; P=0.01; RI 0.83±0.04 vs. 0.86±0.03; P=0.02), hepatic artery (HA) (PI 1.41±0.19 vs. 1.79±0.48; P=0.03; RI 0.71±0.05 vs. 0.80±0.07; P=0.02), and splenic artery (SA) (PI 1.18±0.27 vs. 1.73±0.40; P=0.01; RI 0.66±0.07 vs. 0.73±0.09; P=0.02), and by higher mean flow velocity of HA (52.6±21.6 vs. 26.5±9.5 cm/s; P=0.02) and SMA (49.7±14.5 vs. 33.9±13.1 cm/s; P=0.06). Conclusions Cirrhotic patients poor-responders to nadolol show a pronounced arterial splanchnic vasodilatation at a baseline echo-color-Doppler study. This can be considered a non-invasive clue for the a priori identification of this subgroup of patients.