E Invasive Studies to Measure PortalHypertenslon: Hepatlc Venous Pressure Gradlent

Hepatic venous pressure gradient (HVPG) measurements provide information for diagnosis, prognosis, and management of portal hypertension. The HVPG is the difference between the wedged or occluded hepatic vein pressure and the free hepatic vein pressure. Normal portal pressure (HVPG) ranges from 1 to 5 mm Hg with greater than 5 mm Hg indicating the presence of portal hypertension. In patients with sinusoidal cirrhosis, the HVPG accurately predicts the portal venous pressure gradient. An HVPG greater than 10 mm Hg is predictive of the development of varices. Pharmacologically reducing the HPVG more than 10% at 1 year compared with the baseline measurement significantly lowers the risk of developing varices. Similarly, a 10% increase in HPVG significantly increases the risk of developing varices.

Determining a patient’s HPVG also predicts variceal bleeding, development of hepatic decompensation, determination of response to clinical treatment, and estimations of patient survival. Variceal bleeding can occur in patients with HVPG greater than 12 mm Hg. In patients with acute or ongoing bleeding, an HVPG greater than 20 mm Hg is associated with early rebleeding or uncontrolled bleeding, longer intensive care unit stay, prolonged hospital stay, higher transfusion requirements, and a lower probability of survival.

Patients achieving a reduction in HVPG to less than 12 mm Hg or a reduction in HVPG of 20% after pharmacologic therapy are less likely to develop ascites, spontaneous bacterial peritonitis, hepatorenal syndrome, and hepatic encephalopathy. Unfortunately, only 35-45% of treated patients respond with a 20% decrease in HVPG. Patients, who do not achieve an HVPG of less than 12 mm Hg, or a 20% reduction from their baseline HVPG after pharmacologic treatment, have a greater risk of developing complications of portal hypertension and a higher probability of death. Repeat HPVG measurements obtained 1-3 months after initiating treatment help guide therapeutic decisions.

Abraldes JG, Tarantino I, Turnes J, et al. Hemodynamic response to pharmacological treatment of portal hypertension and longterm prognosis of cirrhosis. Hepatology. 2003;37:902-908. [PMID: 12668985]

Ripoll C, Groszmann R, Garcia-Tsao G, et al. Hepatic venous pressure gradient predicts clinical decompensation in patients with compensated cirrhosis. Gastroenterology. 2007;133:481-488. [PMID: 17681169]

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