Hepatic Venous Pressure Gradient: Worth Another Look?

Abstract

Portal hypertension is one of the most important complications of chronic liver disease and accounts for significant morbidity and mortality. Measurement of the hepatic venous pressure gradient (HVPG) is a simple, invasive, and reproducible method of assessing portal venous pressure. Measurement of HVPG provides the clinician an estimate of the degree of intrahepatic portal flow resistance, guides therapy for variceal bleeding (primary and secondary prophylaxis), assesses feasibility of resection in patients with hepatocellular cancer, and predicts response to therapy of patients with chronic hepatitis C. Achieving hemodynamic targets of reducing the HVPG to <10 mmHg or a 20% reduction from baseline virtually eliminates complications related to portal hypertension from chronic liver disease. This review explores the role of HVPG measurement in the contemporary treatment of patients with cirrhosis and portal hypertension.

Duplex Doppler Ultrasound Examination of the Portal Venous System: An Emerging Novel Technique for the Estimation of Portal Vein Pressure

“…Although the free hepatic venous pressure is elevated in post-sinusoidal obstruction such as Budd-Chiari syndrome, the WHVP is elevated in these patients and so is HVPG. Henceforth, the criteria of WHVP in patients with cardiac cirrhosis are similar to other causes of cirrhosis in terms of diagnosis of portal hypertension as well as in assessing patients on betablocker therapy [19].…”

The Risk Factors for Bleeding of Fundal Varices in Patients with Liver Cirrhosis

“…In the cirrhotic liver, the pressure of the static column of blood created by balloon inflation could not be decompressed at the sinusoidal level due to sinusoidal narrowing and disruption of the normal inter sinusoidal architecture by fibrosis and nodule formation. For this reason, WHVP equilibrated with portal pressure 8,9…”

Liver Stiffness: A Significant Relationship with the Waveform Pattern in the Hepatic Vein

“…Because it was conducted to evaluate portal hemodynamics to determine the severity of portal hypertension and risk of bleeding from varices, only patients with cirrhosis and gastroesophageal varices and those scheduled for variceal treatment underwent the procedure. Free and wedged hepatic venous pressure (WHVP) and the hepatic venous pressure gradient (HVPG) were measured in accordance with a previous study (Parikh 2009). All angiographic procedures were performed by H.M. and T.S., hepatologists/radiologists with more than 10 y of experience at the time of the initial case.…”