| Groszmann RJ, et al.1919. Groszmann RJ, Garcia-Tsao G, Bosch J, Grace ND, Burroughs AK, Planas R, et al. Beta-blockers to prevent gastroesophageal varices in patients with cirrhosis. Portal Hypertension Collaborative Group. N Engl J Med. 2005;353:2254-61. |
Prospective N=213 cirrhotic patients without varices receiving timolol (n=108) vs placebo (n=105) |
Development of gastroesophageal varices or variceal hemorrhage |
NSBB are ineffective in preventing varices/bleeding (39% treated vs 40% placebo; P=0.89) and are associated with adverse events |
| Villanueva C, et al.1717. Villanueva C, Albillos A, Genescà J, Abraldes JG, Calleja JL, Aracil C, et al. Development of hyperdynamic circulation and response to β-blockers in compensated cirrhosis with portal hypertension. Hepatology. 2016;63:197-206. |
Prospective, multicentric, cross-sectional study N=273 cirrhotic with PH (194 with CSPH and 79 with subclinical PH) |
To characterize the hemodynamic profile of each stage of PH in compensated cirrhosis and the response to NSBB according to stage |
Patients with subclinical PH have less hyperdynamic circulation and lower portal pressure reduction using NSBB compared to those with CSPH, suggesting that NSBB are more suitable to prevent decompensation of cirrhosis in patients with CSPH than in earlier stages |
| Villanueva C, et al.1818. Villanueva C, Albillos A, Genescà J, Garcia-Pagan JC, Calleja JL, Aracil C, et al. β blockers to prevent decompensation of cirrhosis in patients with clinically significant portal hypertension (PREDESCI): a randomised, double-blind, placebo-controlled, multicentre trial. Lancet. 2019;393:1597-1608. |
Multicentric prospective, double-blind, RCT (PREDESCI). N=201 with compensated cirrhosis and CSPH without HRBV (100 received propranolol or carvedilol and 101 received placebo) |
NSBB to prevent decompensation of cirrhosis with PH |
Decompensation occurred in 16/100 (16%) patients in the NSBB group versus 27/101 (27%) patients in the placebo group (P=0.041). Long-term treatment with NSBB could increase decompensation-free survival in patients with compensated cirrhosis and CSPH |
| Albrades JC, et al.33. Abraldes JC, Bureau C, Stefanescu H, Augustin S, Ney M, Blasco H, et al. Noninvasive tools and risk of clinically significant portal hypertension and varices in compensated cirrhosis: The “Anticipate” study. Hepatology. 2016;64:2173-84. |
Prospective, multicentric N=518 patients with cACLD |
To develop noninvasive tests-based risk prediction models to provide a point-of-care risk assessment of cACLD patients |
Platelets ≥150.000 and a LSM value of 20 kPa would have a predictive probability for HRBV of 5%, and 30% of the patients showed a predictive probability of HRBV below 5% |
| Pons M, et al.4343. Pons M, Augustin S, Scheiner B, Guillaume M, Rosselli M, Rodrigues SG, et al. Noninvasive Diagnosis of Portal Hypertension in Patients With Compensated Advanced Chronic Liver Disease. Am J Gastroenterol. 2021;116:723-32. |
International cohort study N=836 compensated cirrhotic (358 HCV; 248 NASH; 203 alcohol abuse and 27 HBV) |
To explore the prevalence of PH in the most common etiologies of patients with cACLD and develop classification rules based on LSM, that could be readily used to diagnose or exclude CSPH |
LSM ≥25 kPa is sufficient to rule in CSPH in most etiologies, including non-obese with NASH, but not in obese patients with NASH. LSM ≤15 kPa plus platelets ≥150.000 ruled out CSPH in most etiologies |
| Rabiee A, et al.4545. Rabiee A, Deng Y, Ciarleglio M, Chan JL, Pons M, Genesca J, Garcia-Tsao G. Noninvasive predictors of clinically significant portal hypertension in NASH cirrhosis: Validation of ANTICIPATE models and development of a lab-based model. Hepatol Commun. 2022;6:3324-34. |
Validation study N=245 patients with compensated NASH cirrhosis |
To validate the ANTICIPATE models using baseline data from a multicenter RCT; and to develop and validate a model using laboratory values (FIB4+) |
The ANTICIPATE models performed well in predicting the presence of CSPH in NASH cirrhosis. A model using FIB-4 plus albumin (FIB4+) can be used to predict CSPH when VCTE is not available |
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CSPH: clinical significant portal hypertension; cACLD: compensated advanced chronic liver disease; LSM: liver stiffness measurement.