HVPG course and systemic hemodynamics (mean arterial pressure [MAP] and heart rate [HR]) at baseline and at HVPG-response evaluation in (A) all NASH patients, in (B) NSBB-responders, and in (C) NSBB-non-responders.

HVPG course and systemic hemodynamics (mean arterial pressure [MAP] and heart rate [HR]) at baseline and at HVPG-response evaluation in (A) all NASH patients, in (B) NSBB-responders, and in (C) NSBB-non-responders.

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Background and Aims Non-alcoholic steatohepatitis has become a leading cause of cirrhosis. The prognostic value of (HVPG)-guided NSBB prophylaxis remains to be investigated in the setting of NASH cirrhosis. Methods Patients with NASH cirrhosis and varices undergoing HVPG-guided NSBB therapy were included. HVPG-response to NSBBs was evaluated withi...

Contexts in source publication

Context 1
... beta-blocker induced HVPG-response: Hepatic hemodynamics - Fig. 1 , Supplemental Table S2 Median HVPG-decrease in HVPG-responders was 5.5 ± 2.7 mmHg (or 26 ± 11%): mean baseline-HVPG 20.5 ± 5.2 mmHg vs. response-HVPG 15.1 ± 4.3 mmHg ( p < 0.001). Furthermore, wedged hepatic venous pressure(WHVP; baseline: 29.3 ± 6.3 vs. response-HVPG: 22.9 ± 5.8 mmHg, p < 0.001), mean arterial pres- Table 2 ...
Context 2
... October 4, 2021;11:58 ] Short-term outcomes: bleeding/decompensation during 90 days of follow-up - Fig. 2 A-D , Supplementary Fig. FS-1 During the first 90-days of clinical follow-up, CPS-strata (CPS A vs. B: p = 0.109, CPS A vs. C: p = 0.030, CPS B vs. C: 0.559), MELD ≥15/ < 15 ( p = 0.008) and HVPG-strata ( ≥20/ < 20 mmHg; p = 0.037) were predictive of the occurrence of bleeding/decompensation. NSBB-response did not attain statistical significance -however out of four events during the first 90 days, n = 3 (75%) occurred in NSBB-non-responders compared to n = 1 (15%) in NSBB-responders ( p = 0.172). ...

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In the recently published original article by Paternostro et al., analyzing the prognostic value of HVPG-response to (NSBB) in patients with NASH-related cirrhosis and varices, the authors reported that 55.3% of the patients achieved HVPG-response to NSBB. Presence of diabetes (adjusted odds ratio (aOR) 0.16, p = 0.038) and baseline mean arterial pressure (MAP) (aOR:1.07, p = 0.044) were independent predictors of NSBB- response. Child-Pugh stage B/C, MELD ≥ 15, and HVPG ≥ 20 mmHg but not HVPG response, predicted the composite endpoint of bleeding or decompensation at 90 days and 2 years. While this study adds to the limited existing literature on efficacy and outcomes of NSBB induced HVPG-response in patients with NASH cirrhosis, some issues need to be addressed.