MRI assessment for beta-blockers in portal hypertension

• Research type

  Research Study

• Full title

  Non-invasive assessment of haemodynamic response to beta-blockers using magnetic resonance imaging in patients with portal hypertension

• IRAS ID

  149781

• Contact name

  Jonathan A Fallowfield

• Contact email

  jfallowf@staffmail.ed.ac.uk

• Research summary

  Portal hypertension (PHT, high blood pressure in the portal vein of the liver and its branches) underlies most of the fatal complications of cirrhosis. Current chronic treatment with non-selective beta-blockers (e.g. propranolol) can reduce the risk of bleeding from varices (enlarged veins lining the gullet), but less than one third of patients respond to these drugs and a fifth stop treatment due to side effects. New drugs are emerging that may be more effective and better tolerated. We need to understand why many patients do not respond to beta-blockers (so alternative approaches can be sought) and to monitor the response we need to develop an appropriate diagnostic test; one that is widely available and acceptable to patients. We have optimized a magnetic resonance imaging (MRI)-based method to study the circulation in patients with chronic liver disease and wish to determine its value in studying the effects of drugs in patients in order to target treatments more effectively (‘personalized medicine’).
  In this single-centre pilot study we will randomly allocate male or female adults patients with liver cirrhosis, who need beta-blocker treatment for portal hypertension as part of their standard NHS care, to either propranolol or carvedilol (a newer beta-blocker that is thought to work in a different way) and use our MRI technique to study the effect of these drugs on the circulation. Patients will undergo an MRI scan before commencing beta-blockers and 4 weeks after starting treatment. The effect of these drugs on blood flow in a number of selected blood vessels will be assessed. In the analysis, patients will also be ‘stratified’ (divided into different groups) using a liver disease severity scoring system (Child-Pugh score) to determine whether the stage of liver disease influences the effect of beta-blockers on the circulation.

• REC name

  South East Scotland REC 02

• REC reference

  14/SS/1050

• Date of REC Opinion

  29 Sep 2014

• REC opinion

  Favourable Opinion