P-25 IMPEDANCE CARDIOGRAPHY AND SPLEEN STIFFNESS MEASUREMENT TO ASSESS THERAPEUTIC RESPONSE IN CIRRHOTIC PATIENTS TREATED WITH NON-CARDIOSELECTIVE BETA-BLOCKERS

Conflict of interest

No

Introduction and Objectives

Non-cardioselective beta-blockers (NCBBs) are used as prophylaxis for variceal bleeding but have limitations in therapeutic follow-up. Impedance cardiography (IC) evaluates systemic hemodynamics, and splenic elastography (SE) quantifies spleen stiffness. A decrease in spleen stiffness measurement (SSM) is associated with a reduction in the hepatic venous pressure gradient, which is the ultimate goal of the treatment. This study aimed to describe systemic hemodynamic changes and SSM in cirrhotic patients under prophylaxis with NCBBs using non-invasive methods.

Patients / Materials and Methods

This observational and prospective study involved cirrhotic patients indicated for NCBB treatment at the Military Hospital from July 2022 to June 2024. Hemodynamic assessment was performed using IC with Z_logic® (Exxer®, Argentina) and SSM with FibroScan® (Echosens®, France). Patients were evaluated before treatment and at the target dose.

Results and Discussion

Twenty-six patients participated in the study, of which 14 were men. The mean age was 57.8 ± 18.4 years. Alcoholic cirrhosis was the main etiology (n=10). 69% were classified as Child-Pugh A. The MELD-Na score was 11.8 ± 5.3. Before treatment, patients did not present parameters of hyperdynamic circulation, and the SSM was 58.9 ± 15.1 kPa. In 19 patients, there was a decrease in SSM, with an average value dropping to 47.6 ± 17.3 kPa (p=0.018). Systemic vascular resistance (SVR) was higher in patients with a decrease in SSM (1538.8 ± 1068.9 dyn.s.cm^-5 vs. 985.9 ± 164.3 dyn.s.cm^-5, p=0.042) (Table). A negative correlation was observed between the change in SVR and the decrease in SSM (p=0.029, Pearson's r = -0.438).

Conclusions

Systemic hemodynamic changes and SSM in NCBB-treated patients were described. SSM showed the most significant changes. A correlation was found between the increase in SVR and the decrease in SSM once the target doses were achieved. According to these findings, SVR values could be a marker of an adequate response to NCBBs.

Hemodynamic status in patients who showed a decrease or no decrease in spleen stiffness value under treatment with NCBBs. * Median and interquartile range are provided for these data. Remaining values are expressed as mean ± standard deviation. (¶: p < 0.05).