Measurement of Portal Pressure and Its Role in the Management of Chronic Liver Disease

Abstract

Portal hypertension is a major cause of morbidity and mortality in liver cirrhosis. This article provides a background on the most important aspects of the evaluation of portal hypertension in patients with chronic liver diseases, with special attention to the measurement of portal pressure by hepatic vein catheterization. The rationale, technique, applications, costs, and limitations of measurements of the hepatic venous pressure gradient are thoroughly reviewed. Emerging, noninvasive methodologies for the evaluation of the patient with portal hypertension are also discussed.

Visceral adiposity and insulin resistance are independent predictors of the presence of non-cirrhotic NAFLD-related portal hypertension

“…A HVPG of 45 mm Hg was used to define PHT. 33 A large part of the liver biopsy specimen (42 cm, if available) was stored in formalin aldehyde. Hematoxylineosin stain, sirius red (Fouchet) stain, periodic acid-Schiff stain after diastase, reticulin stain (Gordon-Sweets) and Perl's iron stain were routinely carried out on all biopsy samples and subsequently analyzed by two different experienced pathologists, using the NASH Clinical Research Network Scoring System.…”

Origins of Portal Hypertension in Nonalcoholic Fatty Liver Disease

“…Using umbilical vein pressure as reference, WHVP in cirrhotic patients was found to be almost identical to PVP, and the pressure difference between wedged and free-floating catheter positions defining the hepatic venous pressure gradient (HVPG) became a widely accepted measure of PHT [19,20]. Thus, an HVPG of 5 mm Hg or more indicates PHT and an HVPG of 10 mm Hg or more is defined as clinically significant PHT, predicting the development of esophageal varices and other complications [21,22].…”

Right Atrial Pressure Is Not Adequate to Calculate Portal Pressure Gradient in Cirrhosis: A Clinical-Hemodynamic Correlation Study

“…[4][5][6][7]10,11 The technique to obtain HVPG values is relatively straightforward; however, specific guidelines must be followed to achieve accurate measurements, as emphasized in recent studies. 1,2,12 The HVPG represents the pressure gradient between the portal vein and the inferior vena cava pressure (IVCP) and, therefore, represents the portal perfusion pressure. The WHVP is measured by occluding the hepatic vein, either by wedging the catheter into a small branch of a hepatic vein or by inflating a balloon at the tip of the catheter in a larger hepatic vein; the latter method is recommended because it decreases the variability of measurements.…”

“…In these cases, the IVCP at the level of the hepatic vein should be used to calculate HVPG. 2 In recent years, especially since the introduction of transjugular intrahepatic portosystemic shunt (TIPS), many reports have used right atrial pressure (RAP) as the internal zero reference to calculate the portal pressure gradient (hepatic atrial pressure gradient [HAPG]). [14][15][16][17][18][19][20][21] There are several reasons for this trend.…”

“…[22][23][24] However, no study thus far has assessed the prognostic significance of HAPG either in baseline conditions or after pharmacological therapy, as compared with measurement of the HVPG in patients with cirrhosis and portal hypertension. In this study, our goals were: (1) to determine whether the measurements of HAPG and its changes after drug therapy correlate with prognosis in patients with cirrhosis and portal hypertension; (2) to compare the prognostic value of HAPG with that of HVPG; (3) to determine whether HAPG measurement adds significant information to that of HVPG; and (4) investigate the agreement between portoatrial gradient (PAG) and portocaval gradient (PCG) in patients with TIPS.…”