Gastroenterology

Gastroenterology

Volume 130, Issue 1, January 2006, Pages 120-126
Gastroenterology

Clinical–liver, pancreas, and biliary tract
Deleterious Effects of β-Blockers on Exercise Capacity and Hemodynamics in Patients With Portopulmonary Hypertension

https://doi.org/10.1053/j.gastro.2005.10.013Get rights and content

Background & Aims: It has been suggested that β-blockers might be harmful in pulmonary arterial hypertension. However, no study has evaluated the effect of β-blockers in these patients. The aim of this study was to investigate the effect of β-blockers on exercise capacity and pulmonary hemodynamics in patients with portopulmonary hypertension receiving β-blockers for the prophylaxis of variceal bleeding.

Methods: Ten consecutive patients with moderate to severe portopulmonary hypertension (mean pulmonary artery pressure of 52 [10] mm Hg) underwent a 6-minute walk test and a right heart catheterization at baseline and 2 (1) months after β-blocker withdrawal.

Results: Following β-blocker withdrawal, 9 of 10 patients increased their 6-minute walked distance with a mean increase in the whole group of 79 (78) meters (P = .01). Cardiac output increased by 28% (P < .01) with no change in mean pulmonary artery pressure, resulting in a 19% decrease in pulmonary vascular resistance (P < .01). Increases in cardiac output were related to a 25% increase in heart rate (P < .01), whereas stroke volume was unchanged (P = .65). The improvements in exercise tolerance were associated with increases in chronotropic response (maximal heart rate minus resting heart rate) from 18 (9) to 34 (12) beats/min (P < .01) during the 6-minute walk test.

Conclusions: In patients with moderate to severe portopulmonary hypertension, β-blockers are associated with significant worsening in exercise capacity and pulmonary hemodynamics. These deleterious effects support the contraindication of β-blockers 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.).

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