Non-invasive assessment of haemodynamic response to beta-blockers using magnetic resonance imaging in patients with portal hypertension

Portal hypertension underlies most of the fatal complications of cirrhosis. Current treatment with non-selective beta-blockers (e.g. propranolol) can reduce the risk from variceal bleeding, but less than one third of patients respond to these drugs and at least a fifth stop treatment due to side effects. New drugs are emerging that may be more effective and better tolerated. We need to understand why some patients do not respond to beta-blockers (so alternative approaches can be sought) and to monitor response we need to develop an appropriate diagnostic test; one that is widely available and acceptable to patients. We have optimized a magnetic resonance-based method to study the circulation in patients with liver disease and wish to determine its value in studying the effects of drugs in order to target treatments more effectively (‘personalized medicine’). In this pilot study, we will examine an established drug (propranolol) and an emerging alternative (carvedilol).