Hepatic venous pressure gradient determination in patients with hepatitis C virus-related and alcoholic cirrhosis

Bellis, Lia; Castellacci, Roberto; Montagnese, Fabrizio; Festuccia, Francescaromana; Corvisieri, Paolo; Puoti, Claudio

doi:10.1097/00042737-200310000-00004

Cited by 19 publications

(20 citation statements)

References 22 publications

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“…However, the difference in the etiology of cirrhosis in the three groups would not have altered our results. It has been previously shown that the degree of portal hypertension is not related to the etiology of cirrhosis [12,29], and we expect HVPG to be similar in different etiologies.…”

Section: Discussionmentioning

confidence: 66%

Hemodynamic Studies in Acute-on-Chronic Liver Failure

et al. 2008

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Section: Discussionmentioning

confidence: 66%

Hemodynamic Studies in Acute-on-Chronic Liver Failure

et al. 2008

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“…2) (expressed as difference between the last and first measurement) had a weak correlation with changes in fibrosis score (r ϭ 0.30, P ϭ 0.045). However, no significant correlation was found between change in grade and HVPG (P ϭ 0.042) and median HVPG did not change (5 mmHg; range, [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. Regarding the whole paired group, the mean of the first evaluations for HVPG was 5.31 Ϯ 2.9 vs. 6.29 Ϯ 4.5 for the last (P ϭ 0.82); when evaluating those with PHT at first measurement, a better correlation was found, with mean first HVPG at 8.4 Ϯ 2.3 vs. 10 Ϯ 5 for the last HVPG (P ϭ 0.076).…”

Section: Total Cohortmentioning

confidence: 99%

“…10 Other studies have correlated HVPG both with severity and etiology of cirrhosis, 3,7,11 with only 1 study documenting a difference between HCV and alcoholic cirrhosis. 12 A significant correlation has been shown between antiviral response and HVPG changes in HCV chronic hepatitis, 13,14 and between HVPG and histological features of cirrhosis. 15 HVPG Ͼ10 mmHg predicts the development of complications of HCV cirrhosis.…”

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confidence: 99%

Hepatic venous pressure gradient to assess fibrosis and its progression after liver transplantation for HCV cirrhosis

et al. 2007

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Progression of fibrosis following recurrent hepatitis C virus (HCV) infection is frequent after liver transplantation (LT).Histology remains the gold standard to assess fibrosis, but the value of hepatic venous pressure gradient (HVPG) is being explored. We evaluated patients with recurrent HCV infection after LT to assess whether HVPG correlates with liver histology, particularly fibrosis. A total of 90 consecutive patients underwent 170 HVPG measurements concomitant with transjugular liver biopsy (TJB), with 31.5 (range, 6-156) months of follow up. Median biopsy length was 22 mm and total portal tract count was 12 (complete 6, partial 6). Median HVPG was 4 mmHg: 38% of patients Ն6 mmHg (portal hypertension, PHT), 13% Ն10 mmHg. HVPG correlated with Ishak stage (r ϭ 0.73, P Ͻ 0.001) for mild (0-3) and severe fibrosis (4-6), and grade score (r ϭ 0.47, P Ͻ 0.001), but neither correlated with interval from LT nor biopsy length. HVPG was Ն10 mmHg in 15 patients: 12 had stage 5 or 6, and 3 severe portal expansion. HVPG was repeated in 49, between 7 and 60 months with weak correlation to fibrosis score (r ϭ 0.30, P ϭ 0.045). A total of 12 patients with HVPG Ն6 mmHg had fibrosis score Յ3, while 8 patients had normal HVPG but fibrosis stage Ն4. These discrepancies were mostly associated with specific histological features such as perisinusoidal fibrosis rather than errors in measuring HVPG. In 29 with HVPG Ͻ6 mmHg at 1 yr, none decompensated compared to 4 of 13 (31%) with PHT. In conclusion, HVPG correlates with fibrosis and its progression, due to recurrent HCV infection, assessed in TJB. Liver Transpl 13:1305Transpl 13: -1311Transpl 13: , 2007 The severity of portal hypertension (PHT) correlates with the severity of liver disease and cirrhosis, both functionally and histologically 1 and also with the Model for End-Stage Liver Disease, 2 such that it has independent prognostic value separate from clinical and laboratory assessment. 2,3 Hepatic vein catheterisation 4 was modified by Groszmann et al. 5 using a balloon catheter. The measurement of hepatic venous pressure gradient (HVPG) (the difference between wedge hepatic venous pressure [WHVP] Ϫ free hepatic venous pressure) is reproducible 6 and is the preferred technique for evaluating PHT, correlating 1:1 with the direct measurement of portal vein pressure in patients with sinusoidal and postsinusoidal causes of cirrhosis, 7,8 particularly alcoholic and viral-related cirrhosis. Normally HVPG ranges from 1 to 5 mmHg; pressures Ն6 mmHg indicate PHT. 6 WHVP increases with progression of chronic hepatitis and PHT, before histologically detectable cirrhosis. 9 A gradient Ͼ5 mmHg was always associated with significant changes in liver biopsy in 1 study, although a normal gradient did not completely rule out cirrhosis, 10 suggesting that WHVP could provide supplementary information to liver biopsy, with a higher predictive value for assessing stage and activity of chronic liver disease, than routine biochemical tests. 10 Other studies have correlated HVPG both with severit...

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“…Measurement of the hepatic venous pressure gradient (HVPG) [the wedged hepatic venous pressure (WHVP) -the free hepatic venous pressure (FHVP)] is a simple, safe procedure and it accurately reflects the portal pressure in patients with alcoholic [13] as well as posthepatitic cirrhosis [13,14,20]. It is now well established that portal pressure must increase above a threshold value of 12 mm Hg for variceal bleeding to occur [2,3].…”

Section: Introductionmentioning

confidence: 99%

Hepatic Venous Pressure Gradient in Cirrhosis: Correlation with the Size of Varices, Bleeding, Ascites, and Child's Status

et al. 2006

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The hepatic venous pressure gradient (HVPG) clearly reflects portal pressure in cirrhotic portal hypertension. Its relation with variceal bleeding has been well studied. We undertook to study the relation of HVPG to variceal size, Child's status, and etiology of cirrhosis. Patients with cirrhotic portal hypertension with esophageal varices underwent HVPG measurement as part of a prospective evaluation. One hundred seventy-six cirrhotics with varices (M:F, 140:36; mean age, 42.6 +/- 13.4 years), 104 with CLD related to viral etiology, 40 with alcoholic liver disease, 26 cryptogenic with cirrhosis, and 6 with miscellaneous causes of CLD underwent HVPG measurement. The mean HVPG was lower in patients with small varices (n = 77; 14.6 +/- 5.9 mm Hg) than in patients with large varices (n = 99; 19.2 +/- 6.6 mm Hg; P < 0.01). In patients with large varices, the mean HVPG in bleeders (n = 37) was higher than in nonbleeders (n = 62) (21.7 +/- 7.2 vs 17.9 +/- 6.2 mm Hg; P < 0.01). The mean HVPG was significantly higher in Child's B (n = 97; 17.4 +/- 6.9 mm Hg) and C (n = 56; 19.0 +/- 5.7 mm Hg) compared to Child's A cirrhotics (n = 23; 12.2 +/- 5.9 mm Hg; P < 0.01), and Child's C compared to Child's B cirrhotics (P = 0.05). HVPG was higher in alcoholic compared to nonalcoholic cirrhotics (20.8 +/- 7.3 vs 16.4 +/- 6.3 mm Hg; P < 0.05), but this was not significant in multivariate analysis. The HVPG was comparable between hepatitis B- and hepatitis C virus-related cirrhotics (P = 0.8). Cirrhotics with ascites had a higher HVPG than those without ascites (18.5 +/- 5.6 vs 16.6 +/- 7.6 mm Hg; P = 0.02). In multivariate analysis, only Child's status, size of varices, and variceal bleed predicted higher HVPG. HVPG is higher in cirrhotics with large varices and a history of bleed. There is a good correlation between HVPG and large varices, bleeder status, and ascites. A higher HVPG reflects more severe liver disease. The etiology of liver disease did not influence the portal pressure.

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Hepatic venous pressure gradient determination in patients with hepatitis C virus-related and alcoholic cirrhosis

Cited by 19 publications

References 22 publications

Hemodynamic Studies in Acute-on-Chronic Liver Failure

Hemodynamic Studies in Acute-on-Chronic Liver Failure

Hepatic venous pressure gradient to assess fibrosis and its progression after liver transplantation for HCV cirrhosis

Hepatic Venous Pressure Gradient in Cirrhosis: Correlation with the Size of Varices, Bleeding, Ascites, and Child's Status

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