Impact of beta‐blockers on cardiopulmonary exercise testing in patients with advanced liver disease

Wallen, M. P. , Hall, A. , Dias, K. A. , Ramos, J. S. , Keating, S. E. , Woodward, A. J. , Skinner, T. L. , Macdonald, G. A. , Arena, R. and Coombes, J. S. (2017) Impact of beta‐blockers on cardiopulmonary exercise testing in patients with advanced liver disease. Alimentary Pharmacology and Therapeutics, 46 8: 1-7. doi:10.1111/apt.14265


Author Wallen, M. P.
Hall, A.
Dias, K. A.
Ramos, J. S.
Keating, S. E.
Woodward, A. J.
Skinner, T. L.
Macdonald, G. A.
Arena, R.
Coombes, J. S.
Title Impact of beta‐blockers on cardiopulmonary exercise testing in patients with advanced liver disease
Journal name Alimentary Pharmacology and Therapeutics   Check publisher's open access policy
ISSN 1365-2036
0269-2813
Publication date 2017-08-14
Sub-type Article (original research)
DOI 10.1111/apt.14265
Open Access Status Not yet assessed
Volume 46
Issue 8
Start page 1
End page 7
Total pages 7
Place of publication Chichester, West Sussex, United Kingdom
Publisher Wiley-Blackwell Publishing
Language eng
Abstract Patients with advanced liver disease may develop portal hypertension that can result in variceal haemorrhage. 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.

To determine the effect of beta-blockers on cardiopulmonary exercise testing variables in patients with advanced liver disease.

This was a cross-sectional analysis of 72 participants who completed a cardiopulmonary exercise test before liver transplantation. 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.

Participants taking beta-blockers (n = 28) had a lower ventilatory threshold (P <.01) and peak oxygen uptake (P = .02), compared to participants not taking beta-blockers. After adjusting for age, the model of end-stage liver-disease score, liver-disease aetiology, presence of refractory ascites and ventilatory threshold remained significantly lower in the beta-blocker group (P = .04). The oxygen uptake efficiency slope was not impacted by beta-blocker use.

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.
Formatted abstract
Background: Patients with advanced liver disease may develop portal hypertension that can result in variceal haemorrhage. 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.
Aim: To determine the effect of beta-blockers on cardiopulmonary exercise testing variables in patients with advanced liver disease.
Methods: This was a cross-sectional analysis of 72 participants who completed a cardiopulmonary exercise test before liver transplantation. 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.
Results: Participants taking beta-blockers (n = 28) had a lower ventilatory threshold (P <.01) and peak oxygen uptake (P = .02), compared to participants not taking beta-blockers. After adjusting for age, the model of end-stage liver-disease score, liver-disease aetiology, presence of refractory ascites and ventilatory threshold remained significantly lower in the beta-blocker group (P = .04). The oxygen uptake efficiency slope was not impacted by beta-blocker use.
Conclusions: 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.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ
Additional Notes Published online 14 August 2017

Document type: Journal Article
Sub-type: Article (original research)
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Created: Thu, 24 Aug 2017, 15:50:58 EST by Sandrine Ducrot on behalf of School of Human Movement and Nutrition Sciences