Doppler modeling in predicting primary pharmacoresistance to propranolol in patients with liver cirrhosis

Objective. To develop a doppler-based hemodynamic model for predicting primary pharmacoresistance to non-selective beta-blockers (NSBBs) in patients with liver cirrhosis (LC) to optimize the prevention strategy for hemorrhagic complications.

Materials and methods. The study included 56 patients with LC and signs of portal hypertension and esophageal varices. The design included doppler ultrasound of the splenoportal vessels at baseline and 2 hours after an acute pharmacological test with propranolol. Patients were divided into responders (n=15) and non-responders (n=41) based on the test results. Independent prognostic factors were identified using multivariate logistic regression analysis.

Results. The baseline mean linear blood flow velocity (V_mean) in the portal vein was significantly higher in the responder group than in non-responders (18,90 cm/s vs. 14,80 cm/s; p=0,02). During the acute pharmacological test, responders showed a more pronounced induced reduction in mean linear velocity in the splenic vein (by 39.24% vs. 11.63% in non-responders; p=0.01) and in its volume velocity (by 39.24% vs. 17.91%, respectively; p=0.05), combined with a trend towards a greater increase in the pulsatility index (PI) of the splenic artery (–17.12% vs. –3.13%; p=0.08). Multivariate regression analysis identified two independent predictors of pharmacoresistance: baseline V_mean in the portal vein of 16.70 cm/s or less (aOR=7.20; 95% CI: 1.50–34.56; p=0.014) and a rigid response of the splenic vein defined as a linear velocity reduction of 39.23% or less (aOR=9.83; 95% CI: 1.97–49.02; p=0.005).

Conclusion. The proposed doppler ultrasound model provided an effective assessment of portal reserve and visceral bed rigidity, creating an objective basis for the early identification of patients with pharmacoresistance to NSBBs.

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