Background And Aims: Cardiac dysfunction is a key factor in the pathogenesis of hepatorenal syndrome, for which terlipressin is the recommended first-line treatment. This study investigates whether long-term terlipressin can ameliorate the subclinical cardiac dysfunction observed in decompensated cirrhosis.
Methods: Twenty-two patients with decompensated cirrhosis and ascites enrolled in a prospective study of home continuous terlipressin infusion were included. Cardiac function was assessed using dobutamine stress echocardiogram before and after 12 weeks of terlipressin. The primary outcome was the impact of terlipressin on cardiac reserve, the change in cardiac output (CO) in response to stress.
Results: The median age was 61 years (interquartile range, 56-64 years), the median Model for End-Stage Liver Disease score was 15 (interquartile range, 12.3-17.0), and 72.7% were male. The increase in CO in response to low-dose dobutamine was significantly higher following terlipressin (↑4.0 L/min [↑57.8%]) as compared with baseline (↑1.8 L/min [21.3%]) (P = .0001). The proportion of patients with impaired cardiac reserve (defined by ΔCO <25% after low-dose dobutamine) reduced from 81.8% at baseline to 40.9% after terlipressin, (P = .02), driven primarily by improvement in inotropic function. Resting CO decreased significantly after terlipressin from 8.9 ± 2.2 L/min to 7.2 ± 1.8 L/min (normal range 5-6 L/min) (P < .001), due to a decrease in stroke volume from 108 to 86 mL/beat (P = .006).
Conclusions: Long-term continuous terlipressin infusion resulted in a significant increase in cardiac reserve and attenuation of the hyperdynamic state usually observed in decompensated cirrhosis. These data provide important mechanistic insight into the pathogenesis and reversibility of cardiac dysfunction in cirrhosis. Future studies are required to evaluate whether long-term terlipressin can prevent hepatic decompensating events such as hepatorenal syndrome in high-risk individuals. Australian New Zealand Clinical Trials Registry, Number: ACTRN12619000891123.
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http://dx.doi.org/10.1016/j.cgh.2024.08.010 | DOI Listing |
BAY 2413555 is a novel selective and reversible positive allosteric modulator of the type 2 muscarinic acetylcholine (M2) receptor, aimed at enhancing parasympathetic signaling and restoring cardiac autonomic balance for the treatment of heart failure (HF). This study tested the safety, tolerability and pharmacokinetics of this novel therapeutic option. REMOTE-HF was a multicenter, double-blind, randomized, placebo-controlled, phase Ib dose-titration study with two active arms.
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Hepatobiliary Surgery, USL Toscana Centro, Pistoia, ITA.
Spontaneous liver bleeding is a rare but life-threatening complication of hepatocellular carcinoma (HCC). The optimal management strategy for this condition remains a topic of ongoing debate. We present the case of a 74-year-old man with cirrhosis and hemorrhagic shock resulting from the spontaneous rupture of HCC.
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Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, MB, Canada; Institute of Cardiovascular Sciences, St.Boniface General Hospital Albrechtsen Research Centre, Winnipeg, MB, Canada.
Purpose: Mobilization within 24 h post-cardiac surgery (CS) supports improved patient health outcomes. Despite being safe and recommended, it is unknown how much mobility takes place post-CS in the intensive care unit (ICU). Behaviour mapping was used to describe patterns of patients' mobility in one CS ICU.
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Department of Cardiology, Ospedale San Luca IRCCS Istituto Auxologico Italiano, Milano, Italy; Department of Management, Information and Production Engineering, University of Bergamo, Dalmine (BG), Italy.
Background: RV reserve has been linked to exercise capacity and prognosis in cardiopulmonary diseases. However, evidence in this setting is limited, due to the complex shape and load dependency of the RV. We sought to study right ventricular (RV) adaptation to exercise by simultaneous three-dimensional echocardiography (3DE) and right heart catheterization (RHC).
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December 2024
IVF Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece.
Thalassemia is an autosomal recessive hereditary chronic hemolytic anemia characterized by a partial or complete deficiency in the synthesis of alpha- or beta-globin chains, which are essential components of adult hemoglobin. Mutations in the globin genes lead to the production of unstable globin chains that precipitate within cells, causing hemolysis. This shortens the lifespan of mature red blood cells (RBCs) and results in the premature destruction of RBC precursors in the bone marrow.
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