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
May 2005
American Journal of Gastroenterology;May2005, Vol. 100 Issue 5, p1110
Academic Journal
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.(Am J Gastroenterol 2005;100:1110–1116)


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