Importance of portosystemic pressure gradient measurement (HVPG) in patients with liver cirrhosis

Česká verzia

Authors: R. Brůha; J. Petrtýl
Authors place of work: IV. interní klinika – klinika gastroenterologie a hepatologie, VFN a 1. LF UK v Praze
Published in the journal: Gastroent Hepatol 2011; 65(3): 143-148
Category: Hepatologie: přehledná práce

Summary

Liver cirrhosis is a serious disease shortening life expectancy. An unavoidable consequence of cirrhosis is portal hypertension, which usually limits the prognosis by its complications. Portal hypertension is a prognostic factor for cirrhosis decompensation, variceal bleeding and even mortality in cirrhotic patients. In the evaluation of portal hypertension, hepatic venous pressure gradient (HVPG) measurement is used. Measurement of HVPG is used in clinical praxis in the following situations: diagnosis of portal hypertension; evaluation of the prognosis of patients with cirrhosis; monitoring the treatment efficacy in the prevention of variceal bleeding; management of acute variceal bleeding. Decrease of HVPG under 12 mm Hg or at least by 20% from the initial value in the treatment with beta-blockers is associated with a lower risk of bleeding from varices or other complications. HVPG over 20 mm Hg is associated with a high risk of early rebleeding from esophageal varices and can influence decisions on early TIPS. HVPG measurement is an invasive, but simple, reproducible and safe catheterization technique with minimum complication rate. Broadly speaking, the most frequent complication is incorrect interpretation of obtained values. HVPG measurement should be a routine technique in centres specializing in the treatment of patients with liver diseases.

Key words:
cirrhosis – hepatic venous pressure gradient – variceal bleeding – portal hypertension

Zdroje

1. Brodanová M et al. Klinická hepatologie. Praha: Grada Avicenum 1993.

2. Sherlock S, Dooley J. Nemoci jater a žlučových cest. České vydání, Nadační fond ČHS 2004.

3. Myers JD, Taylor WJ. An estimation of portal venous pressure by occlusive cathetrization of ahepatic venule. J Clin Invest 1951; 30: 662–663.

4. Thalheimer U, Leandro G, Samonakis DN et al. Assessment of the agreement between wedge hepatic vein pressure and portal vein pressure in cirrhotic patients. Dig Liver Dis 2005; 37(8): 601–608.

5. De Franchis R. Evolving consensus in portal hypertension. Report of the Baveno IV consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol 2005; 43(1): 167–176.

6. Garcia-Tsao G, Groszmann RJ, Fisher RL et al. Portal pressure, presence of gastroesophageal varices and variceal bleeding. Hepatology 1985; 5(3): 419–424.

7. Groszmann RJ, Wongcharatrawee S. The hepatic venous pressure gradient: anything worth doing should be done right. Hepatology 2004; 39(2): 280–282.

8. Zipprich A, Winkler M, Seufferlein T et al. Comparison of balloon vs. straight catheter for the measurement of portal hypertension. Aliment Pharmacol Ther 2010; 32(11–12): 1351–1356.

9. Ready JB, Robertson AD, Goff JS et al. Assessment of the risk of bleeding from esophageal varices by continuous monitoring of portal pressure. Gastroenterology 1991; 100(5 Pt 1): 1403–1410.

10. Villanueva C, Ortiz J, Minana J et al. Somatostatin treatment and risk stratification by continuous portal pressure monitoring during acute variceal bleeding. Gastroenterology 2001; 121(1): 110–117.

11. Avgerinos A, Armonis A, Stefanidis G et al. Sustained rise of portal pressure after sclerotherapy, but not band ligation, in acute variceal bleeding in cirrhosis. Hepatology 2004; 39(6): 1623–1630.

12. Abraldes JG, Villanueva C, Banares R et al. Hepatic venous pressure gradient and prognosis in patients with acute variceal bleeding treated with pharmacologic and endoscopy therapy. J Hepatol 2008; 48(2): 229–236.

13. García-Pagán JC, Caca K, Bureau C et al. Early TIPS (Transjugular Intrahepatic Portosystemic Shunt) Cooperative Study Group. Early use of TIPS in patients with cirrhosis and variceal bleeding. N Engl J Med 2010; 362: 2370–2379.

14. Monescillo A, Martínez-Lagares F, Ruiz-del-Arbol L et al. Influence of portal hypertension and its early decompression by TIPS placement on the outcome of variceal bleeding. Hepatology 2004; 40(4): 793–801.

15. Feu F, Garcia-Pagan JC, Bosh J et al. Relation between portal pressure response to pharmacotherapy and risk of recurrent variceal haemorrhage in patients with cirrhosis. Lancet 1995; 346: 1056–1059.

16. McCormick PA, Patch D, Greenslade L et al. Clinical vs hemodynamic response to drugs in portal hypertension. J Hepatol 1998; 28(8982): 1015–1019.

17. Villanueva C, Lopez-Balaguer JM, Aracil C et al. Maintenance of hemodynamic response to treatment for portal hypertension and influence on complications of cirrhosis. J Hepatol 2004; 40(5): 757–765.

18. Albillos A, Banares R, Gonzales M et al. Value of the hepatic venous pressure gradient to monitor drug therapy for portal hypertension: a meta-analysis. Am J Gastroenterol 2007; 102(5): 1116–1126.

19. Villanueva C, Aracil C, Colomo A et al. Acute hemodynamic response to beta-blockers and prediction of long-term outcome in primary prophylaxis of variceal bleeding. Gastroenterology 2009; 137(1): 119–128.

20. De Franchis R. Updating consensus in portal hypertension: report of the Baveno III consensus workshop on definitions, methodology and therapeutic strategies in portal hypertension. J Hepatol 2000; 33(5): 846–852.

21. Bureau C, Péron JM, Alric L et al. „A La Carte“ treatment of portal hypertension: Adapting medical therapy to hemodynamic response for the prevention of bleeding. Hepatology 2002; 36(6): 1361–1366.

22. de Francis R. Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol 2010; 53: 762–768.

23. Thalheimer U, Bellis L, Puoti C et al. Should we routinely measure portal pressure in patients with cirrhosis, using hepatic venous pressure gradient (HVPG) as a guide for prophylaxis and therapy of bleeding and rebleeding? Eur J Intern Med 2011; 22(1): 5–7.

24. Merkel C, Bolognesi M, Sacerdoti D et al. The hemodynamic response to medici treatment of portal hypertension as a predictor of clinical effectiveness in the primary profylaxis of variceal bleeding in cirrhosis. Hepatology 2000; 32(5): 930–934.

25. Groszmann RJ, Bosh J, Grace ND et al. Hemodynamic events in a prospective randomized trial of propranolol versus placebo in the prevention of a first variceal hemorrhage. Gastroenterology 1990; 99: 1401–1407.

26. Hicken BL, Sharara AI, Abrams GA et al. Hepatic venous pressure gradient measurements to assess response to primary prophylaxis in patients with cirrhosis: a decision analytical study. Aliment Pharmacol Ther 2003; 17(1): 145–153.

27. Kalambokis G, Manosou P, Vibhakorn S et al. Transjugular liver biopsy–indications, adequacy, quality of specimens, and complications–a systematic review. J Hepatol 2007; 47(2): 284–294.

28. Vibhakorn S, Cholongitas E, Kalambokis G et al. A comparison of four- versus three-pass transjugular biopsy using a 19-G Tru-Cut needle and a randomized study using a cassette to prevent biopsy fragmentation. Cardiovasc Intervent Radiol 2009; 32(3): 508–513.

29. Cholongitas E, Senzolo M, Standish R et al. A systematic review of the quality of liver biopsy specimen.Am J Clin Pathol 2006; 125(5): 710–721.

30. Armonis A, Patch D, Burroughs A. Hepatic venous pressure measurement: an old test as a new prognostic marker in Cirrhosis? Hepatology 1997; 25(1): 245–248.

31. Vorobioff J, Groszmann RJ, Pibacea E et al. Prognostic value of hepatic venous pressure gradient measurement in alcoholic cirrhosis: a 10-year prospective study. Gastroenterology 1996; 111(3): 701–709.

32. Triantos CK, Nikolopoulou V, Burroughs AK. Review article: the therapeutic and prognostic benefit of portal pressure reduction in cirrhosis, Aliment Pharmacol Ther 2008; 28(8): 943–952.

33. Ripoll C, Groszmann R, Garia-Tsao G et al: Hepatic venous pressure gradient predicts clinical decompensation in patients with compensated cirrhosis. Gastroenterology 2007; 133(2): 481–488.

34. Bosch J, Mastai R, Krawetz D et al. Hemodynamic evaluation of the patients with portal hypertension. Semin Liver Dis 1986; 6(4): 309–317.

35. Morali GA, Sniderman KW, Deitel KM et al. Is sinusoidal portal hypertension a necessary factor for the development of hepatic ascites? J Hepatol 1992; 16(1–2): 249–250.

36. Vorobioff J, Groszmann RJ, Picabea E et al. Prognostic value of sequential measurement of portal pressure in alcoholic cirrhotic patients (Abstract). Hepatology 1994; 20: 103A.

37. Conn HO, Grace ND, Bosch J et al. Propranolol in the prevention of the first haemorrhage from esophagogastric varices: a multicenter, randomised clinical trial. Hepatology 1990; 13(5): 902–912.

38. Feu F, Garcia-Pagan JC, Bosch J et al. Relation between portal pressure response to pharmacotherapy and risk of recurrent variceal haemorrhage in patients with cirrhosis. Lancet 1995; 345(8982): 1056–1059.

39. Ripoll C, Groszmann RJ, Garcia-Tsao G et al. Hepatic venous pressure gradient predicts development of hepatocellular carcinoma independently of severity of cirrhosis. J Hepatol 2009; 50(5): 923–928.

40. Burroughs AK, Grossmann RJ, Bosch J et al. Assessment of therapeutic benefit of antiviral therapy in chronic hepatitis C: is hepatic venous pressure gradient a better end point? Gut 2002; 50(3): 425–427.

41. Rincon D, Lo Iacono O, Ripoll C et al. Prognostic value of hepatic venous pressure gradient for in-hospital mortality of patients with severe acute alcoholic hepatitis. Aliment Pharmacol Ther 2007; 25(7): 841–848.

42. Abraldes JG, Tarantino I, Turnes J et al. Hemodynamic response to pharmacological treatment of portal hypertension and long-term prognosis of cirrhosis. Hepaology 2003; 37(4): 902–908.

43. Villanueva C, Balanzó J, Novella MT et al. Nadolol plus isosorbide mononitrate compared with sclerotherapy for the prevention of variceal rebleeding. N Engl J Med 1996; 334(25): 1624–1629.

44. Bruha R, Vitek L, Petrtyl J et al: The effect of carvedilol on portal hypertension depends on the severity of endothelial activation and inflammatory changes. Scand J Gastroenterol 2006; 41(12): 1454–1463.