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Cardiac, Neuroadrenergic, and Portal Hemodynamic Effects of Prolonged Aldosterone Blockade in Postviral Child A Cirrhosis
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Cardiac, Neuroadrenergic, and Portal Hemodynamic Effects of Prolonged Aldosterone Blockade in Postviral Child A Cirrhosis
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Journal Article
Cardiac, Neuroadrenergic, and Portal Hemodynamic Effects of Prolonged Aldosterone Blockade in Postviral Child A Cirrhosis
2005
Overview
The present study was designed to determine the effects of long-term antialdosterone treatment on cardiac structural and functional alterations, portal and systemic hemodynamic as well as adrenergic dysfunction characterizing Child A cirrhotic patients with F1 esophageal varices.
Twenty-two Child A postviral preascitic cirrhotic patients were randomly allocated to 200 mg/day K-Canrenoate (13 patients, age 59.6 +/- 2.2 yr, mean + SEM) or no-drug treatment (9 patients, age 61.8 +/- 2.3) for a 6-month-period. Measurements, which included hepatic venous pressure gradient (HVPG), left ventricular wall thickness, left ventricular end-diastolic volume and diastolic function (LVWT, LVEDV, and E/A ratio, echocardiography), and muscle sympathetic nerve activity (MSNA, microneurography, peroneal nerve), were obtained at baseline and following 6 months of drug or no-drug treatment. Ten healthy age-matched subjects served as controls.
Cirrhotic patients were characterized by increased HVPG, LVWT, and MSNA values and by a depressed E/A ratio. K-Canrenoate treatment significantly reduced HVPG (from 15.3 +/- 1.0 to 13.8 +/- 0.8 mmHg, p < 0.05), LVWT (from 21.8 +/- 0.5 to 20.7 +/- 0.6 mm, p < 0.02), and LVEDV (from 99.2 +/- 7 to 86.4 +/- 6 ml, p < 0.01), leaving E/A ratio and MSNA almost unaltered. No significant change was observed in the untreated group of cirrhotic patients followed for 6 months without intervention.
These data provide evidence that aldosterone blockade by long-term K-Canrenoate administration improves hepatic hemodynamics by lowering HVPG and ameliorates cardiac structure and function by favoring a reduction in LVWT and LVEDV as well. They also show, however, that this therapeutic intervention neither improves left ventricular diastolic dysfunction nor exerts sympathoinhibitory effects.
Publisher
Blackwell Publishing,Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
Subject
Adrenergic Fibers - drug effects
/ Biological and medical sciences
/ Canrenoic Acid - therapeutic use
/ Esophageal and Gastric Varices - drug therapy
/ Female
/ Gastroenterology. Liver. Pancreas. Abdomen
/ Heart Ventricles - drug effects
/ Hepatic Veins - drug effects
/ Humans
/ Liver Circulation - drug effects
/ Liver Cirrhosis - drug therapy
/ Liver Cirrhosis - physiopathology
/ Liver. Biliary tract. Portal circulation. Exocrine pancreas
/ Male
/ Mineralocorticoid Receptor Antagonists - therapeutic use
/ Peroneal Nerve - drug effects
/ Portal System - drug effects
