Cardiac, neuroadrenergic, and portal hemodynamic effects of prolonged aldosterone blockade in postviral Child A cirrhosis

Massimo Pozzi, Guido Grassi, Laura Ratti, Giorgio Favini, Raffaella Dell'Oro, Elena Redaelli, Ivan Calchera, Giuseppe Boari, Giuseppe Mancia

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Original languageEnglish
Pages (from-to)1110-1116
Number of pages7
JournalAmerican Journal of Gastroenterology
Volume100
Issue number5
DOIs
Publication statusPublished - May 2005

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Aldosterone
Fibrosis
Venous Pressure
Hemodynamics
Liver
Pharmaceutical Preparations
Therapeutics
Peroneal Nerve
Esophageal and Gastric Varices
Left Ventricular Dysfunction
Stroke Volume
Adrenergic Agents
Echocardiography
Muscles

ASJC Scopus subject areas

  • Gastroenterology

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Cardiac, neuroadrenergic, and portal hemodynamic effects of prolonged aldosterone blockade in postviral Child A cirrhosis. / Pozzi, Massimo; Grassi, Guido; Ratti, Laura; Favini, Giorgio; Dell'Oro, Raffaella; Redaelli, Elena; Calchera, Ivan; Boari, Giuseppe; Mancia, Giuseppe.

In: American Journal of Gastroenterology, Vol. 100, No. 5, 05.2005, p. 1110-1116.

Research output: Contribution to journalArticle

Pozzi, Massimo ; Grassi, Guido ; Ratti, Laura ; Favini, Giorgio ; Dell'Oro, Raffaella ; Redaelli, Elena ; Calchera, Ivan ; Boari, Giuseppe ; Mancia, Giuseppe. / Cardiac, neuroadrenergic, and portal hemodynamic effects of prolonged aldosterone blockade in postviral Child A cirrhosis. In: American Journal of Gastroenterology. 2005 ; Vol. 100, No. 5. pp. 1110-1116.
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abstract = "OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.",
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T1 - Cardiac, neuroadrenergic, and portal hemodynamic effects of prolonged aldosterone blockade in postviral Child A cirrhosis

AU - Pozzi, Massimo

AU - Grassi, Guido

AU - Ratti, Laura

AU - Favini, Giorgio

AU - Dell'Oro, Raffaella

AU - Redaelli, Elena

AU - Calchera, Ivan

AU - Boari, Giuseppe

AU - Mancia, Giuseppe

PY - 2005/5

Y1 - 2005/5

N2 - OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

AB - OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

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