Clinical–liver, pancreas, and biliary tractDeleterious Effects of β-Blockers on Exercise Capacity and Hemodynamics in Patients With Portopulmonary Hypertension
Section snippets
Study Population
Ten consecutive patients referred to our institution for the evaluation of suspected portopulmonary hypertension while receiving β-blockers were prospectively evaluated. Pulmonary arterial hypertension was defined as mean pulmonary artery pressure >25 mm Hg and pulmonary vascular resistance >240 dyn · s · cm−5 with a pulmonary artery occlusion pressure <15 mm Hg.2 Portal hypertension was defined as the presence of esophageal varices at esophagogastroscopy or hepatic venous pressure gradient >4 mm
Results
During this period, no patient referred to our institution for portopulmonary hypertension and receiving β-blockers was excluded.
Discussion
The present study shows that in the context of moderate to severe portopulmonary hypertension, withdrawing β-blockers improves exercise capacity and resting pulmonary hemodynamics. These improvements appear to be mostly related to removal of the negative chronotropic effect of β-blockers and less importantly to a decrease in pulmonary vascular resistance.
Significant improvements in modified NYHA functional class distribution and 6-minute walked distance were observed in most patients after
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Supported by a fellowship grant from Université Laval, Québec, Canada (to S.P.).