Mapping the hemodynamic effects of terlipressin in patients with hepatorenal syndrome using advanced magnetic resonance imaging
Background & aims: Terlipressin improves renal function in ∼40% of patients with hepatorenal syndrome–acute kidney injury (HRS-AKI). Nonetheless, the pathophysiological mechanisms of terlipressin remain unclear. Therefore, we investigated the cardiovascular changes that occur after terlipres...
Saved in:
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-08-01
|
| Series: | JHEP Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589555925001302 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1839638617357549568 |
|---|---|
| author | Karen Vagner Danielsen Jens Dahlgaard Hove Puria Nabilou Thit Mynster Kronborg Signe Wiese Hartwig Roman Siebner Robert Scott Susan T. Francis Guruprasad P. Aithal Søren Møller Flemming Bendtsen |
| author_facet | Karen Vagner Danielsen Jens Dahlgaard Hove Puria Nabilou Thit Mynster Kronborg Signe Wiese Hartwig Roman Siebner Robert Scott Susan T. Francis Guruprasad P. Aithal Søren Møller Flemming Bendtsen |
| author_sort | Karen Vagner Danielsen |
| collection | DOAJ |
| description | Background & aims: Terlipressin improves renal function in ∼40% of patients with hepatorenal syndrome–acute kidney injury (HRS-AKI). Nonetheless, the pathophysiological mechanisms of terlipressin remain unclear. Therefore, we investigated the cardiovascular changes that occur after terlipressin is given to patients with HRS-AKI. Methods: Cardiac and phase-contrast magnetic resonance imaging were used to assess cardiac function, as well as renal, splanchnic, and peripheral blood flow changes after the first bolus of 2 mg terlipressin in 10 patients with HRS-AKI, six of whom also had acute-on-chronic liver failure. Hemodynamic changes were analyzed using the Wilcoxon matched-pairs signed-rank test. Patients were followed prospectively to investigate any associations between terlipressin-induced hemodynamic changes and clinical outcomes. Results: Cardiac output (CO) decreased by 15% following terlipressin (p <0.01). Despite this decrease in CO, renal artery blood flow increased by 23% (p <0.01), and the renal artery blood flow percentage of CO increased by 49% (p = 0.01). Superior mesenteric artery blood flow and femoral artery blood flow decreased by 27% and 40%, respectively (both p <0.01). Mean arterial pressure (MAP) and systemic vascular resistance increased by 13% and 32%, respectively (both p <0.01). Baseline renal artery blood flow correlated with serum creatinine (p <0.01). By contrast, changes in renal artery blood flow and other cardiocirculatory variables did not correlate with changes in serum creatinine after terlipressin or with mortality. Conclusions: Terlipressin increases renal artery blood flow, reduces CO, and alleviates splanchnic and peripheral vasodilatation. These effects, combined with an increase in MAP, appear to explain the therapeutic benefits of terlipressin in patients with HRS-AKI. Impact and implications: This study is the first to provide a detailed mapping of the hemodynamic changes following terlipressin treatment in patients critically ill with HRS-AKI. The results indicate that the beneficial effects of terlipressin are driven by selective peripheral and splanchnic vasoconstriction, which redistributes blood flow, normalizes MAP, and ultimately improves renal perfusion despite reduced cardiac output. This study also highlights the advantages of using magnetic resonance imaging as a non-invasive method to evaluate pharmacological interventions, with the potential to contribute to future advances in personalized medicine for patients with cirrhosis. Clinical Trials registration: NCT03483272. |
| format | Article |
| id | doaj-art-d3e1a3c4881d41f6afbcd3be3d48b4ea |
| institution | Matheson Library |
| issn | 2589-5559 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JHEP Reports |
| spelling | doaj-art-d3e1a3c4881d41f6afbcd3be3d48b4ea2025-07-05T04:47:37ZengElsevierJHEP Reports2589-55592025-08-0178101452Mapping the hemodynamic effects of terlipressin in patients with hepatorenal syndrome using advanced magnetic resonance imagingKaren Vagner Danielsen0Jens Dahlgaard Hove1Puria Nabilou2Thit Mynster Kronborg3Signe Wiese4Hartwig Roman Siebner5Robert Scott6Susan T. Francis7Guruprasad P. Aithal8Søren Møller9Flemming Bendtsen10Centre of Gastroenterology, Medical Division, Copenhagen University Hospital Hvidovre, Denmark; Department of Clinical Physiology and Nuclear Medicine, Centre of Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Corresponding author. Address: Centre of Gastroenterology, Medical Division, Copenhagen University Hospital Hvidovre, Kettegaard Alle 30, DK-2650 Hvidovre, Denmark. Tel.: +45 22 43 94 49.Department of Clinical Physiology and Nuclear Medicine, Centre of Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Department of Cardiology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, DenmarkCentre of Gastroenterology, Medical Division, Copenhagen University Hospital Hvidovre, DenmarkCentre of Gastroenterology, Medical Division, Copenhagen University Hospital Hvidovre, DenmarkCentre of Gastroenterology, Medical Division, Copenhagen University Hospital Hvidovre, DenmarkInstitute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Department of Neurology, Copenhagen University Bispebjerg and Frederiksberg, Copenhagen, DenmarkNational Institute for Health and Care Research (NIHR) Nottingham Biomedical Research Unit, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UKSir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UKNational Institute for Health and Care Research (NIHR) Nottingham Biomedical Research Unit, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK; Nottingham Digestive Diseases Centre, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UKDepartment of Clinical Physiology and Nuclear Medicine, Centre of Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, DenmarkCentre of Gastroenterology, Medical Division, Copenhagen University Hospital Hvidovre, Denmark; Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, DenmarkBackground & aims: Terlipressin improves renal function in ∼40% of patients with hepatorenal syndrome–acute kidney injury (HRS-AKI). Nonetheless, the pathophysiological mechanisms of terlipressin remain unclear. Therefore, we investigated the cardiovascular changes that occur after terlipressin is given to patients with HRS-AKI. Methods: Cardiac and phase-contrast magnetic resonance imaging were used to assess cardiac function, as well as renal, splanchnic, and peripheral blood flow changes after the first bolus of 2 mg terlipressin in 10 patients with HRS-AKI, six of whom also had acute-on-chronic liver failure. Hemodynamic changes were analyzed using the Wilcoxon matched-pairs signed-rank test. Patients were followed prospectively to investigate any associations between terlipressin-induced hemodynamic changes and clinical outcomes. Results: Cardiac output (CO) decreased by 15% following terlipressin (p <0.01). Despite this decrease in CO, renal artery blood flow increased by 23% (p <0.01), and the renal artery blood flow percentage of CO increased by 49% (p = 0.01). Superior mesenteric artery blood flow and femoral artery blood flow decreased by 27% and 40%, respectively (both p <0.01). Mean arterial pressure (MAP) and systemic vascular resistance increased by 13% and 32%, respectively (both p <0.01). Baseline renal artery blood flow correlated with serum creatinine (p <0.01). By contrast, changes in renal artery blood flow and other cardiocirculatory variables did not correlate with changes in serum creatinine after terlipressin or with mortality. Conclusions: Terlipressin increases renal artery blood flow, reduces CO, and alleviates splanchnic and peripheral vasodilatation. These effects, combined with an increase in MAP, appear to explain the therapeutic benefits of terlipressin in patients with HRS-AKI. Impact and implications: This study is the first to provide a detailed mapping of the hemodynamic changes following terlipressin treatment in patients critically ill with HRS-AKI. The results indicate that the beneficial effects of terlipressin are driven by selective peripheral and splanchnic vasoconstriction, which redistributes blood flow, normalizes MAP, and ultimately improves renal perfusion despite reduced cardiac output. This study also highlights the advantages of using magnetic resonance imaging as a non-invasive method to evaluate pharmacological interventions, with the potential to contribute to future advances in personalized medicine for patients with cirrhosis. Clinical Trials registration: NCT03483272.http://www.sciencedirect.com/science/article/pii/S2589555925001302Acute kidney injuryAcute-on-chronic liver failurePortal hypertensionTerlipressinPharmacodynamic |
| spellingShingle | Karen Vagner Danielsen Jens Dahlgaard Hove Puria Nabilou Thit Mynster Kronborg Signe Wiese Hartwig Roman Siebner Robert Scott Susan T. Francis Guruprasad P. Aithal Søren Møller Flemming Bendtsen Mapping the hemodynamic effects of terlipressin in patients with hepatorenal syndrome using advanced magnetic resonance imaging JHEP Reports Acute kidney injury Acute-on-chronic liver failure Portal hypertension Terlipressin Pharmacodynamic |
| title | Mapping the hemodynamic effects of terlipressin in patients with hepatorenal syndrome using advanced magnetic resonance imaging |
| title_full | Mapping the hemodynamic effects of terlipressin in patients with hepatorenal syndrome using advanced magnetic resonance imaging |
| title_fullStr | Mapping the hemodynamic effects of terlipressin in patients with hepatorenal syndrome using advanced magnetic resonance imaging |
| title_full_unstemmed | Mapping the hemodynamic effects of terlipressin in patients with hepatorenal syndrome using advanced magnetic resonance imaging |
| title_short | Mapping the hemodynamic effects of terlipressin in patients with hepatorenal syndrome using advanced magnetic resonance imaging |
| title_sort | mapping the hemodynamic effects of terlipressin in patients with hepatorenal syndrome using advanced magnetic resonance imaging |
| topic | Acute kidney injury Acute-on-chronic liver failure Portal hypertension Terlipressin Pharmacodynamic |
| url | http://www.sciencedirect.com/science/article/pii/S2589555925001302 |
| work_keys_str_mv | AT karenvagnerdanielsen mappingthehemodynamiceffectsofterlipressininpatientswithhepatorenalsyndromeusingadvancedmagneticresonanceimaging AT jensdahlgaardhove mappingthehemodynamiceffectsofterlipressininpatientswithhepatorenalsyndromeusingadvancedmagneticresonanceimaging AT purianabilou mappingthehemodynamiceffectsofterlipressininpatientswithhepatorenalsyndromeusingadvancedmagneticresonanceimaging AT thitmynsterkronborg mappingthehemodynamiceffectsofterlipressininpatientswithhepatorenalsyndromeusingadvancedmagneticresonanceimaging AT signewiese mappingthehemodynamiceffectsofterlipressininpatientswithhepatorenalsyndromeusingadvancedmagneticresonanceimaging AT hartwigromansiebner mappingthehemodynamiceffectsofterlipressininpatientswithhepatorenalsyndromeusingadvancedmagneticresonanceimaging AT robertscott mappingthehemodynamiceffectsofterlipressininpatientswithhepatorenalsyndromeusingadvancedmagneticresonanceimaging AT susantfrancis mappingthehemodynamiceffectsofterlipressininpatientswithhepatorenalsyndromeusingadvancedmagneticresonanceimaging AT guruprasadpaithal mappingthehemodynamiceffectsofterlipressininpatientswithhepatorenalsyndromeusingadvancedmagneticresonanceimaging AT sørenmøller mappingthehemodynamiceffectsofterlipressininpatientswithhepatorenalsyndromeusingadvancedmagneticresonanceimaging AT flemmingbendtsen mappingthehemodynamiceffectsofterlipressininpatientswithhepatorenalsyndromeusingadvancedmagneticresonanceimaging |