Hepatic Venous Pressure Gradient: Clinical Use in Chronic Liver Disease

Overview

Journal Clin Mol Hepatol

Specialty Gastroenterology

Date 2014 Apr 24

PMID 24757653

Citations 67

Authors

Ki Tae Suk

Affiliations

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Abstract

Portal hypertension is a severe consequence of chronic liver diseases and is responsible for the main clinical complications of liver cirrhosis. Hepatic venous pressure gradient (HVPG) measurement is the best available method to evaluate the presence and severity of portal hypertension. Clinically significant portal hypertension is defined as an increase in HVPG to >10 mmHg. In this condition, the complications of portal hypertension might begin to appear. HVPG measurement is increasingly used in the clinical fields, and the HVPG is a robust surrogate marker in many clinical applications such as diagnosis, risk stratification, identification of patients with hepatocellular carcinoma who are candidates for liver resection, monitoring of the efficacy of medical treatment, and assessment of progression of portal hypertension. Patients who had a reduction in HVPG of ≥ 20% or to ≤ 12 mmHg in response to drug therapy are defined as responders. Responders have a markedly decreased risk of bleeding/rebleeding, ascites, and spontaneous bacterial peritonitis, which results in improved survival. This review provides clinical use of HVPG measurement in the field of liver disease.

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References

Monescillo A, Martinez-Lagares F, Ruiz-Del-Arbol L, Sierra A, Guevara C, Jimenez E . Influence of portal hypertension and its early decompression by TIPS placement on the outcome of variceal bleeding. Hepatology. 2004; 40(4):793-801. DOI: 10.1002/hep.20386. View

DAmico G, Luca A . Natural history. Clinical-haemodynamic correlations. Prediction of the risk of bleeding. Baillieres Clin Gastroenterol. 1997; 11(2):243-56. DOI: 10.1016/s0950-3528(97)90038-5. View

de Franchis R, Primignani M . Natural history of portal hypertension in patients with cirrhosis. Clin Liver Dis. 2001; 5(3):645-63. DOI: 10.1016/s1089-3261(05)70186-0. View

Vizzutti F, Arena U, Romanelli R, Rega L, Foschi M, Colagrande S . Liver stiffness measurement predicts severe portal hypertension in patients with HCV-related cirrhosis. Hepatology. 2007; 45(5):1290-7. DOI: 10.1002/hep.21665. View

DAmico G, Pagliaro L, Bosch J . Pharmacological treatment of portal hypertension: an evidence-based approach. Semin Liver Dis. 2000; 19(4):475-505. DOI: 10.1055/s-2007-1007133. View

Boleslawski E, Petrovai G, Truant S, Dharancy S, Duhamel A, Salleron J . Hepatic venous pressure gradient in the assessment of portal hypertension before liver resection in patients with cirrhosis. Br J Surg. 2012; 99(6):855-63. DOI: 10.1002/bjs.8753. View

Krook H . Estimation of portal venous pressure by occlusive hepatic vein catheterization. Scand J Clin Lab Invest. 1953; 5(3):285-92. DOI: 10.3109/00365515309094199. View

Zhou K, Lu L . Assessment of fibrosis in chronic liver diseases. J Dig Dis. 2009; 10(1):7-14. DOI: 10.1111/j.1751-2980.2008.00356.x. View

DellEra A, Sotela J, Fabris F, Petazzi G, Reati R, Iannuzzi F . Primary prophylaxis of variceal bleeding in cirrhotic patients: a cohort study. Dig Liver Dis. 2008; 40(12):936-43. DOI: 10.1016/j.dld.2008.03.017. View

10.

Vlachogiannakos J, Kougioumtzian A, Triantos C, Viazis N, Sgouros S, Manolakopoulos S . Clinical trial: The effect of somatostatin vs. octreotide in preventing post-endoscopic increase in hepatic venous pressure gradient in cirrhotics with bleeding varices. Aliment Pharmacol Ther. 2007; 26(11-12):1479-87. DOI: 10.1111/j.1365-2036.2007.03539.x. View

11.

Suk K, Kim D, Kim C, Park S, Cheong J, Cho S . Diagnostic accuracy of biomarkers measured in the hepatic vein and peripheral vein in the prediction of advanced fibrosis in patients with chronic viral hepatitis. Clin Biochem. 2012; 45(13-14):1075-80. DOI: 10.1016/j.clinbiochem.2012.04.031. View

12.

Guha I, Myers R, Patel K, Talwalkar J . Biomarkers of liver fibrosis: what lies beneath the receiver operating characteristic curve?. Hepatology. 2011; 54(4):1454-62. DOI: 10.1002/hep.24515. View

13.

Burroughs A, Thalheimer U . Hepatic venous pressure gradient in 2010: optimal measurement is key. Hepatology. 2010; 51(6):1894-6. DOI: 10.1002/hep.23710. View

14.

Merkel C, Bolognesi M, Sacerdoti D, Bombonato G, Bellini B, Bighin R . The hemodynamic response to medical treatment of portal hypertension as a predictor of clinical effectiveness in the primary prophylaxis of variceal bleeding in cirrhosis. Hepatology. 2000; 32(5):930-4. DOI: 10.1053/jhep.2000.19322. View

15.

Burroughs A, Groszmann R, Bosch J, Grace N, Garcia-Tsao G, Patch D . Assessment of therapeutic benefit of antiviral therapy in chronic hepatitis C: is hepatic venous pressure gradient a better end point?. Gut. 2002; 50(3):425-7. PMC: 1773121. DOI: 10.1136/gut.50.3.425. View

16.

Vinel J, Cassigneul J, Levade M, Voigt J, Pascal J . Assessment of short-term prognosis after variceal bleeding in patients with alcoholic cirrhosis by early measurement of portohepatic gradient. Hepatology. 1986; 6(1):116-7. DOI: 10.1002/hep.1840060122. View

17.

Suk K, Kim H, Namkung S, Han S, Choi K, Park S . Diagnostic accuracy of hepatic venous pressure gradient measurement in the prediction of stage 1 compensated liver cirrhosis in patients with chronic hepatitis B. Eur J Gastroenterol Hepatol. 2013; 25(10):1170-6. DOI: 10.1097/MEG.0b013e3283613139. View

18.

Kumar M, Kumar A, Hissar S, Jain P, Rastogi A, Kumar D . Hepatic venous pressure gradient as a predictor of fibrosis in chronic liver disease because of hepatitis B virus. Liver Int. 2008; 28(5):690-8. DOI: 10.1111/j.1478-3231.2008.01711.x. View

19.

Garcia-Tsao G, Friedman S, Iredale J, Pinzani M . Now there are many (stages) where before there was one: In search of a pathophysiological classification of cirrhosis. Hepatology. 2010; 51(4):1445-9. PMC: 2882065. DOI: 10.1002/hep.23478. View

20.

Merkel C, Montagnese S . Hepatic venous pressure gradient measurement in clinical hepatology. Dig Liver Dis. 2011; 43(10):762-7. DOI: 10.1016/j.dld.2011.03.002. View