Patients with advanced liver disease may develop portal hypertension that can result in variceal hemorrhage.
Beta-blockers reduce portal pressure and minimise haemorrhage risk.
These medications may attenuate measures of cardiopulmonary performance, such as the ventilatory threshold and peak oxygen uptake measured via cardiopulmonary exercise testing.
Dr Coombes and colleagues from Australia determined the effect of beta-blockers on cardiopulmonary exercise testing variables in patients with advanced liver disease.
The research team performed a cross-sectional analysis of 72 participants who completed a cardiopulmonary exercise test before liver transplantation.
|Beta-blockers had a lower ventilatory threshold|
|Alimentary Pharmacology & Therapeutics|
All participants remained on their usual beta-blocker dose and timing prior to the test.
Variables measured during cardiopulmonary exercise testing included the ventilatory threshold, peak oxygen uptake, heart rate, oxygen pulse, the oxygen uptake efficiency slope and the ventilatory equivalents for carbon dioxide slope.
The researchers found that participants taking beta-blockers had a lower ventilatory threshold, and peak oxygen uptake, compared to participants not taking beta-blockers.
After adjusting for age, the team observed that the model of end-stage liver-disease score, liver-disease etiology, presence of refractory ascites and ventilatory threshold remained significantly lower in the beta-blocker group.
The researchers observed that oxygen uptake efficiency slope was not impacted by beta-blocker use.
Dr Coombes' team comments, "Ventilatory threshold is reduced in patients with advanced liver disease taking beta-blockers compared to those not taking the medication."
"This may incorrectly risk stratify patients on beta-blockers and has implications for patient management before and after liver transplantation."
"The oxygen uptake efficiency slope was not influenced by beta-blockers and may therefore be a better measure of cardiopulmonary performance in this patient population."