Measurement of the Hepatic Venous Pressure Gradient (HVPG)
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.
KeywordsHepatic venous pressure gradient HVPG Portal hypertension Clinically significant portal hypertension CSPH Portal pressure measurement Hemodynamic response