- Title
- Impact of beta-blockers on cardiopulmonary exercise testingin patients with advanced liver disease
- Creator
- Wallen, Matthew; Hall, Adrian; Dias, Katrin; Ramos, Joyce; Keating, Shelley; Woodward, Aidan; Skinner, Tina; Macdonald, Graeme; Arena, Ross; Coombes, Jeff
- Date
- 2017
- Type
- Text; Journal article
- Identifier
- http://researchonline.federation.edu.au/vital/access/HandleResolver/1959.17/159340
- Identifier
- vital:11998
- Identifier
-
https://doi.org/10.1111/apt.14265
- Identifier
- ISSN:0269-2813
- Abstract
- Summary Background: Patients with advanced liver disease may develop portal hypertensionthat can result in variceal haemorrhage. Beta-blockers reduce portal pressure andminimise haemorrhage risk. These medications may attenuate measures of car-diopulmonary performance, such as the ventilatory threshold and peak oxygenuptake measured via cardiopulmonary exercise testing. Aim: To determine the effect of beta-blockers on cardiopulmonary exercise testingvariables in patients with advanced liver disease. Methods: This was a cross-sectional analysis of 72 participants who completed acardiopulmonary exercise test before liver transplantation. All participants remainedon their usual beta-blocker dose and timing prior to the test. Variables measuredduring cardiopulmonary exercise testing included the ventilatory threshold, peakoxygen uptake, heart rate, oxygen pulse, the oxygen uptake efficiency slope and theventilatory equivalents for carbon dioxide slope. Results: Participants taking beta-blockers (n = 28) had a lower ventilatory threshold(P <.01) and peak oxygen uptake (P = .02), compared to participants not takingbeta-blockers. After adjusting for age, the model of end-stage liver-disease score,liver-disease aetiology, presence of refractory ascites and ventilatory thresholdremained significantly lower in the beta-blocker group (P = .04). The oxygen uptakeefficiency slope was not impacted by beta-blocker use. Conclusions: Ventilatory threshold is reduced in patients with advanced liver dis-ease taking beta-blockers compared to those not taking the medication. This mayincorrectly risk stratify patients on beta-blockers and has implications for patientmanagement before and after liver transplantation. The oxygen uptake efficiencyslope was not influenced by beta-blockers and may therefore be a better measureof cardiopulmonary performance in this patient population.
- Relation
- Alimentary Pharmacology and Therapeutics Vol. , no. (2017), p. 1-7
- Rights
- © 2017 John Wiley & Sons Ltd
- Rights
- This metadata is freely available under a CCO license
- Subject
- 1103 Clinical Sciences; 1115 Pharmacology and Pharmaceutical Sciences
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