Introduction Portal pressure underlies variceal development, bleeding and mortality but is not routinely assessed. Universal endoscopic screening is advised in cirrhosis with primary prophylaxis given if varices >5 mm diameter. This is labour intensive and costly, but non-invasive predictors of varices are unreliable. Cirrhosis is associated with a hyperdynamic circulation and quick, easy, non-invasive assessment of this is now possible. The aim of this study was to evaluate whether non-invasive assessment of systemic haemodynamics in cirrhosis can identify patients with significant oesophageal varices.
Methods We studied 29 cirrhotic patients. Systemic haemodynamics were assessed non-invasively using the Finometer® (TNO instruments, Amsterdam), and analysed with Beatscope® software. Portal pressure was assessed by measurement of the hepatic venous pressure gradient (HVPG). Gastroscopy assessed variceal size, Japanese score and 1-year probability of bleeding according to the NIEC index.
Results 69% male, median age 47 (42–55) years, Child-Pugh (CP) score 6 (Class A 18, Class B 10, Class C 1) and MELD 10 (8–13). 90% alcoholic cirrhosis, 66% abstinent. HVPG positively correlated with CP score (r=0.58, p=0.001), cardiac index (r=0.53, p=0.005) and heart rate (r=0.62, p<0.001) but not with peripheral vascular resistance (PVR) (r=−0.17, p=0.632). A significant negative correlation was seen between PVR and both cardiac output (r=−0.95, p<0.001) and cardiac index (r=−0.81, p<0.001). HVPG correlated positively with variceal size (r=0.64, p<0.001). Cardiac output and cardiac index positively correlated whereas PVR negatively correlated with variceal size (r=0.53, p=0.003, r=0.61, p<0.001, r=−0.41, p=0.029, respectively). Significant differences in haemodynamics were seen between patients with no or small varices and medium or large varices (Abstract 065). No significant differences were seen in serum albumin, prothrombin time, platelet count or presence of stigmata of chronic liver disease and size of varices.
Conclusion Non-invasive assessment of systemic haemodynamics in cirrhosis identifies the hyperdynamic circulation and can distinguish between absent/small and medium/large sized varices. This technique appears promising as a tool to help identify a group of patients who would most benefit from endoscopic screening and primary prophylaxis.
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