A Pilot Study: Defining Peripheral Endothelial Function in Portal Hypertensive Cirrhotic Patients
A Pilot Study: Defining Peripheral Endothelial Function in Portal Hypertensive Cirrhotic Patients
Rationale for the study:

 To try and define PEF in cirrhotic patients with CSPH, and maybe to try to find a correlation
 between HVPG ( hepatic vein pressure gradient ) result and PEF result in a way that the
 result of the PEF test will be able to predict if a patient has CSPH (yes of no). By this, to
 try and develop a portable office-based device that can produce immediate results in a
 non-invasive manner in cirrhotic patients and help in evaluating prognosis in these patients
 in a noninvasive manner.

 Aim:

 The aim of this study is to try and characterize the peripheral endothelial function (PEF) in
 patient with cirrhosis and CSPH. This will be evaluated by measuring the PEF in every patient
 before evaluating his HVPG level in a hemodynamic study.
To try and define PEF in cirrhotic patients with CSPH, and maybe to try to find a correlation
 between HVPG result and PEF result in a way that the result of the PEF test will be able to
 predict if a patient has CSPH (yes of no). By this, to try and develop a portable
 office-based device that can produce immediate results in a non-invasive manner in cirrhotic
 patients and help in evaluating prognosis in these patients in a noninvasive manner
Inclusion Criteria:

 1. > 18 years old (Male/Female) and not more than 75 years old

 2. Diagnosis of cirrhosis:

 i. By liver biopsy ii. Or strong suspicion of cirrhosis by accepted criteria for the
 clinical diagnosis of cirrhosis (e.g. peripheral edema or varices, palpable hard left lobe
 of the liver, small right lobe span or palpable splenomegaly), and/or radiological evidence
 of cirrhosis (by abdominal US, CT, or MRI, showing a nodular liver and/or portosystemic
 collaterals with portal vein patency and/or ascites and/or splenomegaly, and/or colloid
 shift on a colloid-isotope liver-spleen scan), and/or laboratory variables (platelets
 <100,000/mm3, albumin< 3.5g/dL, or INR >1.3) and/or presence of esophageal varices (without
 previous variceal bleeding episode) or HVPG≥12mmHg from previous testing, or by FIbroscan
 or Fibrotest results showing fibrosis stage- 4.

 c. Has been scheduled for hemodynamic study testing. d. Patients should have a Child Pugh
 score A or higher

 Exclusion Criteria:

 1. Patients already receiving beta blockers

 2. Hepatocellular carcinoma

 3. Portal vein thrombosis

 4. Cholestatic liver disease

 5. Severe heart, pulmonary or renal disease.

 6. Patients with Ischemic heart disease

 7. Patients with diabetes mellitus

 8. Any major surgery in the past 3 months.

 9. Patient is a recipient of any organ transplant

 10. Patient, based on the opinion of the investigator, should not be enrolled into this
 study.

 11. Patients unable or unwilling to sign informed consent

 12. Patients that are participating in other clinical trials evaluating experimental
 treatments or procedures or have participated in a clinical trial in the past 3
 months.

 13. Active smoking

 14. Uncontrolled hypertension

 Withdrawal criteria:

 1. Patient that based on the opinion of the investigator should be withdrawl from the
 study due to no compliance

 2. Patient wish to stop participate in study.