Prognostic value of a single HVPG measurement and Doppler-ultrasound evaluation in patients with cirrhosis and portal hypertension

Berzigotti, Annalisa; Rossi, Valentina A.; Tiani, Carolina; Pierpaoli, Lucia; Zappoli, P.; Riili, Anna; Serra, Carla; Andreone, Pietro; Morelli, Cristina; Golfieri, Rita; Rossi, Cristina; Magalotti, Donatella; Zoli, Marco

doi:10.1007/s00535-010-0360-z

Cited by 71 publications

(60 citation statements)

References 28 publications

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“…This technique is safe when patients have coagulopathy, because the access site for hepatic vein catheterization is usually the jugular vein [1,2]. The WHVP is equivalent to sinusoidal pressure, which indirectly reflects PVP [2,[6][7][8]10].…”

Section: Discussionmentioning

confidence: 99%

“…Portal hypertension in humans is often evaluated using hepatic vein pressure [1,2,7,10,11,17]. This technique is safe when patients have coagulopathy, because the access site for hepatic vein catheterization is usually the jugular vein [1,2].…”

Section: Discussionmentioning

confidence: 99%

“…The currently favored method for determining PVP in humans involves catheterizing the hepatic vein and measuring wedged hepatic venous pressure (WHVP) and free hepatic venous pressure (FHVP) using a balloon catheter [1,2,6,10,11,14]. The value of WHVP is equivalent to that of indirect PVP in dogs [4,15].…”

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Three Minimally Invasive Methods of Measuring of Portal Vein Pressure in Healthy Dogs

Sakamoto

Sakai

Watari

2012

The Journal of Veterinary Medical Science

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ABSTRACT. We compared wedged hepatic venous pressure (WHVP), splenic pulp pressure (SPP) and trans-splenic portal vein pressure (TSPVP) in healthy dogs. We found that portal blood pressure could be measured in dogs using any of these techniques. The WHVP, SPP and TSPVP were 7.8 ± 1.0, 6.2 ± 0.8 and 6.8 ± 1.2 mmHg, respectively. Measuring SPP using ultrasound is most simple and minimally invasive, and it might be useful for evaluating portal hypertension in dogs with liver diseases. KEY WORDS: canine, catheterization, portal hypertension, portal pressure, ultrasound. doi: 10.1292/jvms.11-0549; J. Vet. Med. Sci. 74(10): 1299-1302, 2012 Portal hypertension (PH) is caused by excessive resistance to a given blood flow in the portal circulation, and it is classified based on anatomical localization, such as prehepatic, intrahepatic, and posthepatic. In dogs, intrahepatic PH can be caused by parenchymal liver diseases, such as severe chronic hepatitis/cirrhosis (CH) and primary hypoplasia of the portal vein (PHPV) [3,16]. Although understanding portal vein pressure (PVP) is important to identify whether these conditions involve PH, PH has been indirectly indicated in dogs based on clinical consequences including the development of ascites and acquired portosystemic collaterals (APSCs) [3,16]. Therefore, PVP in dogs has been mainly measured during the surgical attenuation of congenital portosystemic shunts (CPSS) under laparotomy [5,12,13,19].Catheterization is a minimally invasive method of measuring blood pressure. The currently favored method for determining PVP in humans involves catheterizing the hepatic vein and measuring wedged hepatic venous pressure (WHVP) and free hepatic venous pressure (FHVP) using a balloon catheter [1,2,6,10,11,14]. The value of WHVP is equivalent to that of indirect PVP in dogs [4,15]. The splenic pulp can be percutaneously catheterized to obtain PVP using laparoscopic guidance [18], and thus measuring splenic pulp pressure (SPP) in dogs might be quite simple. The technique used for percutaneous trans-splenic catheterization of the portal vein using ultrasound guidance in anesthetized dogs has been described [9], and although it might be useful for managing PH, it has not been used to measure pressure. Furthermore, PVP has not been measured using the three techniques described above under the same conditions. The present study compares the outcomes of three minimally invasive methods of measuring PVP in healthy dogs. MATERIALS AND METHODSAnimals: Animals used in this study were six healthy beagle dogs, 3 males and 3 females, 3-6 (median, 5.2) years old and weighing 9.4-12.4 (median, 10.1) kg. All of the dogs were confirmed as being healthy by clinical examination, complete blood cell count, serum biochemistry, abdominal radiography and ultrasonography. All the dogs were cared for according to the principles outlined in the Guide for the Care and Use of Laboratory Animals approved by the College of Bioresouce Sciences, Nihon University.Anesthesia: The dogs were premedicated with atropine ...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Three Minimally Invasive Methods of Measuring of Portal Vein Pressure in Healthy Dogs

Sakamoto

Sakai

Watari

2012

The Journal of Veterinary Medical Science

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“…The most commonly reported parameters associated with CSPH and EVs in compensated patients include signs of hypersplenism, such as low platelet count, 6 -12 large spleen size, 7,10,13 or their combination (platelet to spleen ratio), 14 dilatation of the portal vein system or presence of collaterals on ultrasound 8,15,16 and increase in the Child-Pugh score. 6,8,9,17 However, none of these methods were accurate enough when tested in independent validation series, 5,13 and some of them, such as a complete assessment of the portal vein system by ultrasound, were not easy to perform and required specific long-term training.…”

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confidence: 99%

Elastography, Spleen Size, and Platelet Count Identify Portal Hypertension in Patients With Compensated Cirrhosis

et al. 2013

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BACKGROUND & AIMS:Noninvasive methods are needed to identify clinically significant portal hypertension (CSPH) and esophageal varices (EVs) in patients with compensated cirrhosis. We looked for markers of the presence of CSPH and EVs in patients with cirrhosis. METHODS: We performed a cross-sectional study that included a training set of 117 patients with compensated cirrhosis, confirmed by histology, from a tertiary referral center. Spleen diameter was measured by ultrasound and liver stiffness (LS) was measured by transient elastography; endoscopy was used as the standard for detection of EVs and measurements of hepatic venous pressure gradient were used as the standard for identifying CSPH. We assessed the ability of platelet count, spleen diameter, LS, and combinations of these factors (ie, ratio of platelet count to spleen size, and LS ϫ spleen size/platelet count [LSPS]) to identify patients with CSPH and EV. The analysis included 2 new statistical models: the PH risk score and the varices risk score. Results were validated using an independent series of 56 patients with compensated patients from another center. RESULTS: LS was the best single noninvasive variable for identifying patients with CSPH (area under the receiver operating characteristic, 0.883; 95% confidence interval [CI], 0.824 -0.943; P Ͻ .0001). The area under the receiver operating characteristic value increased when LS was combined with platelet count and spleen size, either as LSPS (0.918; 95% CI, 0.872Ϫ0.965; P Ͻ .0001) or PH risk score (0.935; 95% CI, 0.893-0.977; P Ͻ .0001). More than 80% of patients were accurately classified using LSPS and PH risk score. Analyses of the varices risk score and LSPS were superior to all other noninvasive tests for identifying patients with EVs (area under the receiver operating characteristic, 0.909; 95% CI, 0.841Ϫ0.954 and 0.882; 95% CI, 0.810 -0.935, respectively); they correctly classified 85% of patients in the training set and 75% in the validation set. CONCLUSIONS: Combined data on LS, spleen diameter, and platelet count can be used to identify patients with compensated cirrhosis most likely to have CSPH and EV.

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“…Severe PH was used to indicate HVPG > 12 mm Hg (12, 13, 14, 15, 16), ≥ 15 mm Hg (17), or ≥ 16 mm Hg (18, 19). One study defined HVPG ≥ 16 mm Hg as values to predict mortality (20). Two studies defined HVPG ≥ 10 mm Hg as CSPH (8, 21).…”

Section: Resultsmentioning

confidence: 99%

The Accuracy of Ultrasonography for the Evaluation of Portal Hypertension in Patients with Cirrhosis: A Systematic Review

Kim¹,

Cho

Baik

et al. 2015

Korean J Radiol

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ObjectiveStudies have presented conflicting results regarding the accuracy of ultrasonography (US) for diagnosing portal hypertension (PH). We sought to identify evidence in the literature regarding the accuracy of US for assessing PH in patients with liver cirrhosis.Materials and MethodsWe conducted a systematic review by searching databases, including MEDLINE, EMBASE, and the Cochrane Library, for relevant studies.ResultsA total of 14 studies met our inclusion criteria. The US indices were obtained in the portal vein (n = 9), hepatic artery (n = 6), hepatic vein (HV) (n = 4) and other vessels. Using hepatic venous pressure gradient (HVPG) as the reference, the sensitivity (Se) and specificity (Sp) of the portal venous indices were 69-88% and 67-75%, respectively. The correlation coefficients between HVPG and the portal venous indices were approximately 0.296-0.8. No studies assess the Se and Sp of the hepatic arterial indices. The correlation between HVPG and the hepatic arterial indices ranged from 0.01 to 0.83. The Se and Sp of the hepatic venous indices were 75.9-77.8% and 81.8-100%, respectively. In particular, the Se and Sp of HV arrival time for clinically significant PH were 92.7% and 86.7%, respectively. A statistically significant correlation between HVPG and the hepatic venous indices was observed (0.545-0.649).ConclusionSome US indices, such as HV, exhibited an increased accuracy for diagnosing PH. These indices may be useful in clinical practice for the detection of significant PH.

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Prognostic value of a single HVPG measurement and Doppler-ultrasound evaluation in patients with cirrhosis and portal hypertension

Abstract: HVPG holds an independent predictive value for first decompensation and death in patients with CSPH. The ultrasonographic detection of collaterals allows the non-invasive identification of patients with HVPG ≥ 16 mmHg, who are at higher risk.

Cited by 71 publications

References 28 publications

Three Minimally Invasive Methods of Measuring of Portal Vein Pressure in Healthy Dogs

Three Minimally Invasive Methods of Measuring of Portal Vein Pressure in Healthy Dogs

Elastography, Spleen Size, and Platelet Count Identify Portal Hypertension in Patients With Compensated Cirrhosis

The Accuracy of Ultrasonography for the Evaluation of Portal Hypertension in Patients with Cirrhosis: A Systematic Review

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