Liver Diseases pp 447-450 | Cite as

Measurement of the Hepatic Venous Pressure Gradient (HVPG)

  • Thomas ReibergerEmail author


Portal hypertension is the main driver for complications in patients with cirrhosis. The hepatic venous pressure gradient (HVPG) is invasively measured by catheterization of the liver veins and calculated as the difference between the wedged hepatic venous pressure (WHVP) and the free hepatic venous pressure (FHVP). Importantly, the use of the HVPG instead of the WHVP as an indirect surrogate marker for portal hypertension, the bias from increased of intra-abdominal pressure is reduced, and thus HVPG better reflects portal venous pressure in patients with cirrhosis.

The physiological HVPG ranges from 2 to 5 mmHg, while mild portal hypertension is defined as HVPG 6–9 mmHg. With the development of clinically significant portal hypertension (CSPH, HVPG ≥10 mmHg) patients with compensated advanced chronic liver disease (cACLD) are at higher risk for development of first decompensation. In turn, a hemodynamic response to non-selective betablocker (NSBB) therapy—as defined by a decrease in HVPG of >10% from baseline or the absolute values <12 mmHg—indicates a low risk of variceal (re)-bleeding and a favourable prognosis.


Hepatic venous pressure gradient HVPG Portal hypertension Clinically significant portal hypertension CSPH Portal pressure measurement Hemodynamic response 


  1. 1.
    Reiberger T, Püspök A, Schoder M, et al. Austrian consensus guidelines on the management and treatment of portal hypertension (Billroth III). Wien Klin Wochenschr. 2017;129:135–58. Accessed 25 Aug 2018.CrossRefGoogle Scholar
  2. 2.
    De Franchis R, Abraldes JG, Bajaj J, et al. Expanding consensus in portal hypertension Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. J Hepatol. 2015;63(3):743–52.CrossRefGoogle Scholar
  3. 3.
    Ripoll C, Groszmann R, Garcia-Tsao G, et al. Hepatic venous pressure gradient predicts clinical decompensation in patients with compensated cirrhosis. Gastroenterology. 2007;133(2):481–8.CrossRefGoogle Scholar
  4. 4.
    Mandorfer M, Kozbial K, Schwabl P, et al. Sustained virologic response to interferon-free therapies ameliorates HCV-induced portal hypertension. J Hepatol. 2016;65(4):692–9.CrossRefGoogle Scholar
  5. 5.
    Abraldes JG, Tarantino I, Turnes J, et al. Hemodynamic response to pharmacological treatment of portal hypertension and long-term prognosis of cirrhosis. Hepatology. 2003;37(4):902–8.CrossRefGoogle Scholar
  6. 6.
    Groszmann RJ, Garcia-Tsao G, Bosch J, et al. Beta-blockers to prevent gastroesophageal varices in patients with cirrhosis. N Engl J Med. 2005;353(21):2254–61.CrossRefGoogle Scholar
  7. 7.
    Ferlitsch A, Bota S, Paternostro R, et al. Evaluation of a new balloon occlusion catheter specifically designed for measurement of hepatic venous pressure gradient. Liver Int. 2015;35(9):2115–20.CrossRefGoogle Scholar
  8. 8.
    Abraldes JG, Sarlieve P, Tandon P. Measurement of portal pressure. Clin Liver Dis. 2014;18(4):779–92.CrossRefGoogle Scholar
  9. 9.
    Berzigotti A, Seijo S, Reverter E, et al. Assessing portal hypertension in liver diseases. Expert Rev Gastroenterol Hepatol. 2013;7:141–55.CrossRefGoogle Scholar
  10. 10.
    Simón-Talero M, Roccarina D, Martínez J, et al. Association between portosystemic shunts and increased complications and mortality in patients with cirrhosis. Gastroenterology. 2018;154(6):1694–1705.e4.CrossRefGoogle Scholar
  11. 11.
    Vilgrain V, Lebrec D, Menu Y, et al. Comparison between ultrasonographic signs and the degree of portal hypertension in patients with cirrhosis. Gastrointest Radiol. 1990;15(3):218–22.CrossRefGoogle Scholar
  12. 12.
    Procopet B, Berzigotti A, Abraldes JG, et al. Real-time shear-wave elastography: applicability, reliability and accuracy for clinically significant portal hypertension. J Hepatol. 2015;62:1068–75.CrossRefGoogle Scholar
  13. 13.
    Colecchia A, Colli A, Casazza G, et al. Spleen stiffness measurement can predict clinical complications in compensated HCV-related cirrhosis: a prospective study. J Hepatol. 2014;60:1158–64.CrossRefGoogle Scholar
  14. 14.
    Garcia-Tsao G, Groszmann RJ, Fisher RL, et al. Portal pressure, presence of gastroesophageal varices and variceal bleeding. Hepatology. 1985;5(3):419–24.CrossRefGoogle Scholar
  15. 15.
    Merkel C, Marin R, Angeli P, et al. A placebo-controlled clinical trial of nadolol in the prophylaxis of growth of small esophageal varices in cirrhosis. Gastroenterology. 2004;127(2):476–84.CrossRefGoogle Scholar
  16. 16.
    Hernández-Gea V, Aracil C, Colomo A, et al. Development of ascites in compensated cirrhosis with severe portal hypertension treated with β-blockers. Am J Gastroenterol. 2012;107(3):418–27.CrossRefGoogle Scholar
  17. 17.
    Pinter M, Sieghart W, Reiberger T, et al. Effects of sorafenib on the portal hypertensive syndrome in patients with liver cirrhosis and hepatocellular carcinoma - a proof of concept study. Hepatology. 2011; Scholar
  18. 18.
    Abraldes JG, Albillos A, Bañares R, et al. Simvastatin lowers portal pressure in patients with cirrhosis and portal hypertension: a randomized controlled trial. Gastroenterology. 2009;136(5):1651–8.CrossRefGoogle Scholar
  19. 19.
    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):923–8.CrossRefGoogle Scholar
  20. 20.
    Stremitzer S, Tamandl D, Kaczirek K, et al. Value of hepatic venous pressure gradient measurement before liver resection for hepatocellular carcinoma. Br J Surg. 2011;98(12):1752–8.CrossRefGoogle Scholar
  21. 21.
    Reiberger T, Ulbrich G, Ferlitsch A, et al. Carvedilol for primary prophylaxis of variceal bleeding in cirrhotic patients with haemodynamic non-response to propranolol. Gut. 2013;62(11):1634–41.CrossRefGoogle Scholar
  22. 22.
    Villanueva C, Graupera I, Aracil C, et al. A randomized trial to assess whether portal pressure guided therapy to prevent variceal rebleeding improves survival in cirrhosis. Hepatology. 2017;65(5):1693–707.CrossRefGoogle Scholar
  23. 23.
    Silva-Junior G, Baiges A, Turon F, et al. The prognostic value of hepatic venous pressure gradient in patients with cirrhosis is highly dependent on the accuracy of the technique. Hepatology. 2015;62(5):1584–92.CrossRefGoogle Scholar
  24. 24.
    Kumar A, Sharma P, Sarin SK. Hepatic venous pressure gradient measurement: time to learn! Indian J Gastroenterol. 2008;27(2):74–80.PubMedGoogle Scholar
  25. 25.
    Kalambokis G, Manousou P, Vibhakorn S, et al. Transjugular liver biopsy - indications, adequacy, quality of specimens, and complications - a systematic review. J Hepatol. 2007;47(2):284–94.CrossRefGoogle Scholar
  26. 26.
    Casu S, Berzigotti A, Abraldes JG, et al. A prospective observational study on tolerance and satisfaction to hepatic haemodynamic procedures. Liver Int. 2015;35(3):695–703.CrossRefGoogle Scholar
  27. 27.
    Steinlauf AF, Garcia-Tsao G, Zakko MF, et al. Low-dose midazolam sedation: an option for patients undergoing serial hepatic venous pressure measurements. Hepatology. 1999;29(4):1070–3.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Hepatic Hemodynamic Laboratory, Division of Gastroenterology & Hepatology, Department of Medicine IIIMedical University of ViennaViennaAustria

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