Relationship between hemodynamic parameters and portal venous pressure in cirrhosis patients with portal hypertension

Abstract

Cirrhosis caused by viral and alcoholic hepatitis is an essential cause of portal hypertension (PHT). The incidence of PHT complication is directly proportional to portal venous pressure (PVP), and the clinical research of PVP and its hemodynamic indexes is of great significance for deciding the treatment strategy of PHT. Various techniques are currently being developed to decrease portal pressure but hemodynamic side effects may occur. In this article, the hemodynamic indexes of cirrhotic PHT patients were studied to explore the correlation between the index and PVP and to evaluate the clinical value of Doppler ultrasound in measuring PVP in patients with PHT. This was achieved by selecting 90 cirrhotic PHT patients who underwent transjugular intrahepatic portosystemic shunt in our hospital from June 2015 to September 2019. Fifty healthy people who had a physical examination in the hospital in the same period were selected as the control group. The liver hemodynamic parameters of two groups were measured by Doppler ultrasound, and the cirrhotic PHT patients were graded by the Child–Pugh grading method to evaluate the liver function and measure the PVP value. The results showed that both the central portal vein velocity (PVV) and splenic vein velocity (SVV) of the PHT group were lower than those of the control group. Also, the portal vein diameter (PVD), portal venous flow and splenic vein diameter (SVD) were higher than those of the control group (all Ps < 0.05). Among liver function graded PHT patients, the PVD, PVV, SVD and SVV were significantly different (all Ps < 0.05). Furthermore, the PVP of patients with liver function grades A, B and C was 38.9 ± 1.4, 40.6 ± 5.1 and 42.5 ± 4.8 cmH2O, respectively, with a significant difference. It can be concluded from this study that Doppler ultrasound can be used as a tool for clinical assessment of PHT in cirrhosis patients. Doppler ultrasound showed a good prospect in noninvasive detection of PHT in cirrhosis; however, this technique needs application on large sample population study to validate the results.

Carvedilol Versus Other Nonselective Beta Blockers for Variceal Bleeding Prophylaxis and Death: A Network Meta-analysis

“…Fourth, with regard to HVPG determination, potential parameters such as portal vein flow velocity, portal vein flow volume, portal vein pulsatility index, damping index, portal vein caliber variation, etc, which are helpful in determining the influence of portal circulation hemodynamics, were not investigated in the included studies. 29 , 30 For instance, a high portal pulsatility index seems to be associated with risk of venous congestion, 31 while the damping index might serve as a supplementary tool in evaluating the severity of portal hypertension. 32 Fifth, although an RCT showed that NSBBs reduced the risk of hepatic decompensation in patients with CSPH by 49% compared with placebo, 8 RCTs comparing different NSBBs on preventing hepatic decompensation are lacking.…”

Development of a Direct Non-Puncture Device for Measuring Portal Venous Pressure during Liver Transplantation—A Swine Model

“…Hepatic vein catheterization and measurement of HVPG are the gold standards for this purpose and correlate well with portal pressure. However, current methods have limitations, including the risk of vascular and graft damage with direct catheterization and the indirect determination of the PVP with noninvasive methods that do not provide accurate values [7,8,[31][32][33]. In this respect, PVPMD can obviate many of Furthermore, we also determined the consistency of the two measurements in each experiment using alternate-form reliability analysis.…”

Preventing Small-for-size Syndrome in Living Donor Liver Transplantation: Guidelines From the ILTS-iLDLT-LTSI Consensus Conference

“…130 Intraoperative decision on employing measures to modulate the graft inflow may require evaluation of both PVP and PVF parameters and must be correlated closely with the central venous pressure. 130,138,139 There is a definite need for standardization of techniques to measure the PVP and PVF because these intraoperative numbers guide the pharmacological or surgical PIM.…”