Prognostic Value of Measuring DsAz by MRI in Cirrhotic Patients on Prophylactic Treatment With β Blocker (AzyMR)
Prognostic Value of Measuring DsAz by MRI in Cirrhotic Patients on Prophylactic Treatment With β Blocker (AzyMR)
Portal hypertension (PHT) that leads to esophageal varices is clinically present, at the time
 of diagnosis, in 60% of cirrhotic patients (Groszmann NEJM 2005). Variceal bleeding is a
 life-threatening complication. The yearly incidence of the first variceal bleeding in
 cirrhotic patients is estimated to 4%. This risk increases to 15% when medium or large
 varices are initially present, (D'amico Baillieres Clin Gastroenterol 1997); Therefore, for
 patient with medium or large varices a primary prophylaxis treatment with nonselective
 beta-blockers must be instituted decreasing risk of bleeding approximately by half (d'amico
 Hepatology 2005).

 The method to evaluate the efficacy of beta blockers treatment is the hepatic venous pressure
 gradient (HVPG). HVPG < 12 mmHg or a decrease of HVPG of 20% after beta blocker treatment
 reduce dramatically the risk of bleeding (Feu F. Lancet 1995). But a good response (HVPG < 12
 mmHg or reduction > 20%) to beta blockers was observed only in almost 30 % of patients. In
 non responder patients, the variceal bleeding incidence is estimated to 24 % at 2 years.

 In this situation, alternative treatments to beta-blockers have been suggested: endoscopic
 ligation, which was shown to be as effective as beta blockers in primary prevention, and more
 recently carvedilol (Reiberger, Gut 2012).

 So, HVPG monitoring may provide critical information for patients. However, because of its
 technical requirement and its invasivity, HVPG measurement is not feasible in clinical
 practice . So, there is a general consensus to continue indefinitely beta blockers treatment
 without control of hemodynamic efficiency (merkel J. Hepatology 2009).

 Previous studies have suggested the interest of azygos blood flow measurements for evaluating
 hemodynamic changes in the esophageal collateral vessels of patients with portal hypertension
 (Bosch J. Hepatology 1985 ). More recently Magnetic Resonance Imaging (MRI) has been reported
 to be an efficient technique to assess azygos blood flow (Gouya Radiology 2011) in cirrhotic
 patients. Its feasibility is obviously higher than HVPG measurement.

 However, in the same way that HVPG, a large-scale implementation in clinical practice of
 azygos blood flow measurement by MRI requires to specify minimal absolute threshold, or
 relative post-therapeutic decrease, related with no variceal bleeding.
Inclusion Criteria:

 Cirrhotic patients requiring β blocker in primary prophylaxis of bleeding esophageal
 varices

 Exclusion Criteria:

 -  Patients under 18 year's old

 -  life expectancy of less than one month

 -  Patient already has a vasoactive treatment

 -  patient with CHC or portal vein thrombosis

 -  patient without social security or deprived of freedom

 -  contraindication to MRI

 -  contraindication to beta-blockers

 -  mental state does not allow the signing of an informed consent