Hepatic Venous Pressure Measurement and Other Diagnostic Hepatic Hemodynamic Techniques

Chapter

Abstract

Portal hypertension is a very common complication of advanced chronic liver disease (ACLD), and almost invariably occurs during its natural history [1]. Its relevance is due to the fact that it is responsible for the main complications of cirrhosis, including the formation of oesophageal and gastric varices; variceal bleeding; bleeding from portal hypertensive gastropathy, enteropathy and colopathy; ascites; spontaneous bacterial peritonitis; hepatorenal syndrome; hepatic encephalopathy; hepato-pulmonary syndrome; porto-pulmonary hypertension; splenomegaly and hypersplenism [1]. It is important to remark that these are the complications that most often lead to death or require liver transplantation in patients with cirrhosis.

Keywords

Portal hypertension Esophageal varices Ascites Variceal bleeding Upper GI bleeding Beta-adrenergic blockers Propranolol Liver biopsy Hepatic vein catheterisation Portal pressure 

References

  1. 1.
    Tsochatzis EA, Bosch J, Burroughs AK. Liver cirrhosis. Lancet. 2014;383:1749–61.CrossRefPubMedGoogle Scholar
  2. 2.
    Garcia-Tsao G, Abraldes JG, Berzigotti A, Bosch J. Portal hypertensive bleeding in cirrhosis: risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases. Hepatology. 2017;65:310–35.CrossRefPubMedGoogle Scholar
  3. 3.
    Bosch J, Abraldes JG, Berzigotti A, Garcia-Pagan JC. The clinical use of HVPG measurements in chronic liver disease. Nat Rev Gastroenterol Hepatol. 2009;6:573–82.CrossRefPubMedGoogle Scholar
  4. 4.
    Groszmann RJ, Glickman M, Blei AT, Storer E, Conn HO. Wedged and free hepatic venous pressure measured with a balloon catheter. Gastroenterology. 1979;76:253–8.PubMedGoogle Scholar
  5. 5.
    Groszmann RJ, Wongcharatrawee S. The hepatic venous pressure gradient: anything worth doing should be done right. Hepatology. 2004;39:280–2.CrossRefPubMedGoogle Scholar
  6. 6.
    Zipprich A, Winkler M, Seufferlein T, Dollinger MM. Comparison of balloon vs. straight catheter for the measurement of portal hypertension. Aliment Pharmacol Ther. 2010;32:1351–6.CrossRefPubMedGoogle Scholar
  7. 7.
    Brass P, Hellmich M, Kolodziej L, Schick G, Smith AF. Ultrasound guidance versus anatomical landmarks for internal jugular vein catheterization. Cochrane Database Syst Rev. 2015;1:CD006962.PubMedGoogle Scholar
  8. 8.
    Steinlauf AF, Garcia-Tsao G, Zakko MF, Dickey K, Gupta T, Groszmann RJ. Low-dose midazolam sedation: an option for patients undergoing serial hepatic venous pressure measurements. Hepatology. 1999;29:1070–3.CrossRefPubMedGoogle Scholar
  9. 9.
    Casu S, Berzigotti A, Abraldes JG, Baringo MA, Rocabert L, Hernandez-Gea V, Garcia-Pagan JC, et al. A prospective observational study on tolerance and satisfaction to hepatic haemodynamic procedures. Liver Int. 2015;35:695–703.CrossRefPubMedGoogle Scholar
  10. 10.
    La Mura V, Abraldes JG, Berzigotti A, Erice E, Flores-Arroyo A, Garcia-Pagan JC, Bosch J. Right atrial pressure is not adequate to calculate portal pressure gradient in cirrhosis: a clinical-hemodynamic correlation study. Hepatology. 2010;51:2108–16.CrossRefPubMedGoogle Scholar
  11. 11.
    Hari A, Nair HK, De Gottardi A, Baumgartner I, Dufour JF, Berzigotti A. Diagnostic hepatic haemodynamic techniques: safety and radiation exposure. Liver Int. 2017;37:148–54.CrossRefPubMedGoogle Scholar
  12. 12.
    Kalambokis G, Manousou P, Vibhakorn S, Marelli L, Cholongitas E, Senzolo M, Patch D, et al. Transjugular liver biopsy—indications, adequacy, quality of specimens, and complications—a systematic review. J Hepatol. 2007;47:284–94.CrossRefPubMedGoogle Scholar
  13. 13.
    Carrion JA, Navasa M, Bosch J, Bruguera M, Gilabert R, Forns X. Transient elastography for diagnosis of advanced fibrosis and portal hypertension in patients with hepatitis C recurrence after liver transplantation. Liver Transpl. 2006;12:1791–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Blasco A, Forns X, Carrion JA, Garcia-Pagan JC, Gilabert R, Rimola A, Miquel R, et al. Hepatic venous pressure gradient identifies patients at risk of severe hepatitis C recurrence after liver transplantation. Hepatology. 2006;43:492–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Nagula S, Jain D, Groszmann RJ, Garcia-Tsao G. Histological-hemodynamic correlation in cirrhosis—a histological classification of the severity of cirrhosis. J Hepatol. 2006;44:111–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Sethasine S, Jain D, Groszmann RJ, Garcia-Tsao G. Quantitative histological-hemodynamic correlations in cirrhosis. Hepatology. 2012;55:1146–53.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Krogsgaard K, Christensen E, Gluud C, Henriksen JH, Christoffersen P. Variables predicting elevated portal pressure in alcoholic liver disease. Results of a multivariate analysis. Scand J Gastroenterol. 1987;22:82–6.CrossRefPubMedGoogle Scholar
  18. 18.
    Rincon D, Ripoll C, Lo Iacono O, Salcedo M, Catalina MV, Alvarez E, Nunez O, et al. Antiviral therapy decreases hepatic venous pressure gradient in patients with chronic hepatitis C and advanced fibrosis. Am J Gastroenterol. 2006;101:2269–74.CrossRefPubMedGoogle Scholar
  19. 19.
    Roberts S, Gordon A, McLean C, Pedersen J, Bowden S, Thomson K, Angus P. Effect of sustained viral response on hepatic venous pressure gradient in hepatitis C-related cirrhosis. Clin Gastroenterol Hepatol. 2007;5:932–7.CrossRefPubMedGoogle Scholar
  20. 20.
    Burroughs AK, Groszmann R, Bosch J, Grace N, Garcia-Tsao G, Patch D, Garcia-Pagan JC, et al. Assessment of therapeutic benefit of antiviral therapy in chronic hepatitis C: is hepatic venous pressure gradient a better end point? Gut. 2002;50:425–7.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Gluud C, Brok J, Gong Y, Koretz RL. Hepatology may have problems with putative surrogate outcome measures. J Hepatol. 2007;46:734–42.CrossRefPubMedGoogle Scholar
  22. 22.
    Groszmann RJ, Garcia-Tsao G, Bosch J, Grace ND, Burroughs AK, Planas R, Escorsell A, et al. Beta-blockers to prevent gastroesophageal varices in patients with cirrhosis. N Engl J Med. 2005;353:2254–61.CrossRefPubMedGoogle Scholar
  23. 23.
    Ripoll C, Groszmann R, Garcia-Tsao G, Grace N, Burroughs A, Planas R, Escorsell A, et al. Hepatic venous pressure gradient predicts clinical decompensation in patients with compensated cirrhosis. Gastroenterology. 2007;133:481–8.CrossRefPubMedGoogle Scholar
  24. 24.
    Ripoll C, Groszmann RJ, Garcia-Tsao G, Bosch J, Grace N, Burroughs A, Planas R, et al. Hepatic venous pressure gradient predicts development of hepatocellular carcinoma independently of severity of cirrhosis. J Hepatol. 2009;50:923–8.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Bruix J, Castells A, Bosch J, Feu F, Fuster J, Garcia-Pagan JC, Visa J, et al. Surgical resection of hepatocellular carcinoma in cirrhotic patients: prognostic value of preoperative portal pressure. Gastroenterology. 1996;111:1018–22.CrossRefPubMedGoogle Scholar
  26. 26.
    Berzigotti A, Reig M, Abraldes JG, Bosch J, Bruix J. Portal hypertension and the outcome of surgery for hepatocellular carcinoma in compensated cirrhosis: a systematic review and meta-analysis. Hepatology. 2015;61:526–36.CrossRefPubMedGoogle Scholar
  27. 27.
    Bruix J, Reig M, Sherman M. Evidence-based diagnosis, staging, and treatment of patients with hepatocellular carcinoma. Gastroenterology. 2016;150:835–53.CrossRefPubMedGoogle Scholar
  28. 28.
    Garcia-Tsao G, Groszmann RJ, Fisher RL, Conn HO, Atterbury CE, Glickman M. Portal pressure, presence of gastroesophageal varices and variceal bleeding. Hepatology. 1985;5:419–24.CrossRefPubMedGoogle Scholar
  29. 29.
    Casado M, Bosch J, Garcia-Pagan JC, Bru C, Banares R, Bandi JC, Escorsell A, et al. Clinical events after transjugular intrahepatic portosystemic shunt: correlation with hemodynamic findings. Gastroenterology. 1998;114:1296–303.CrossRefPubMedGoogle Scholar
  30. 30.
    Merkel C, Bolognesi M, Bellon S, Zuin R, Noventa F, Finucci G, Sacerdoti D, et al. Prognostic usefulness of hepatic vein catheterization in patients with cirrhosis and esophageal varices. Gastroenterology. 1992;102:973–9.CrossRefPubMedGoogle Scholar
  31. 31.
    Berzigotti A, Rossi V, Tiani C, Pierpaoli L, Zappoli P, Riili A, Serra C, et al. Prognostic value of a single HVPG measurement and Doppler-ultrasound evaluation in patients with cirrhosis and portal hypertension. J Gastroenterol. 2011;46:687–95.CrossRefPubMedGoogle Scholar
  32. 32.
    Stanley AJ, Robinson I, Forrest EH, Jones AL, Hayes PC. Haemodynamic parameters predicting variceal haemorrhage and survival in alcoholic cirrhosis. QJM. 1998;91:19–25.CrossRefPubMedGoogle Scholar
  33. 33.
    Moitinho E, Escorsell A, Bandi JC, Salmeron JM, Garcia-Pagan JC, Rodes J, Bosch J. Prognostic value of early measurements of portal pressure in acute variceal bleeding. Gastroenterology. 1999;117:626–31.CrossRefPubMedGoogle Scholar
  34. 34.
    Garcia-Pagan JC, Caca K, Bureau C, Laleman W, Appenrodt B, Luca A, Abraldes JG, et al. Early use of TIPS in patients with cirrhosis and variceal bleeding. N Engl J Med. 2010;362:2370–9.CrossRefPubMedGoogle Scholar
  35. 35.
    Monescillo A, Martinez-Lagares F, Ruiz-del-Arbol L, Sierra A, Guevara C, Jimenez E, Marrero JM, et al. Influence of portal hypertension and its early decompression by TIPS placement on the outcome of variceal bleeding. Hepatology. 2004;40:793–801.CrossRefPubMedGoogle Scholar
  36. 36.
    Ripoll C, Banares R, Rincon D, Catalina MV, Lo Iacono O, Salcedo M, Clemente G, et al. Influence of hepatic venous pressure gradient on the prediction of survival of patients with cirrhosis in the MELD era. Hepatology. 2005;42:793–801.CrossRefPubMedGoogle Scholar
  37. 37.
    Rincon D, Lo Iacono O, Ripoll C, Gomez-Camarero J, Salcedo M, Catalina MV, Hernando A, et al. Prognostic value of hepatic venous pressure gradient for in-hospital mortality of patients with severe acute alcoholic hepatitis. Aliment Pharmacol Ther. 2007;25:841–8.CrossRefPubMedGoogle Scholar
  38. 38.
    Feu F, Garcia-Pagan JC, Bosch J, Luca A, Teres J, Escorsell A, Rodes J. Relation between portal pressure response to pharmacotherapy and risk of recurrent variceal haemorrhage in patients with cirrhosis. Lancet. 1995;346:1056–9.CrossRefPubMedGoogle Scholar
  39. 39.
    Vorobioff J, Groszmann RJ, Picabea E, Gamen M, Villavicencio R, Bordato J, Morel I, et al. Prognostic value of hepatic venous pressure gradient measurements in alcoholic cirrhosis: a 10-year prospective study. Gastroenterology. 1996;111:701–9.CrossRefPubMedGoogle Scholar
  40. 40.
    D’Amico G, Garcia-Pagan JC, Luca A, Bosch J. Hepatic vein pressure gradient reduction and prevention of variceal bleeding in cirrhosis: a systematic review. Gastroenterology. 2006;131:1611–24.CrossRefPubMedGoogle Scholar
  41. 41.
    Abraldes JG, Tarantino I, Turnes J, Garcia-Pagan JC, Rodes J, Bosch J. Hemodynamic response to pharmacological treatment of portal hypertension and long-term prognosis of cirrhosis. Hepatology. 2003;37:902–8.CrossRefPubMedGoogle Scholar
  42. 42.
    Turnes J, Garcia-Pagan JC, Abraldes JG, Hernandez-Guerra M, Dell'Era A, Bosch J. Pharmacological reduction of portal pressure and long-term risk of first variceal bleeding in patients with cirrhosis. Am J Gastroenterol. 2006;101:506–12.CrossRefPubMedGoogle Scholar
  43. 43.
    La Mura V, Abraldes JG, Raffa S, Retto O, Berzigotti A, Garcia-Pagan JC, Bosch J. Prognostic value of acute hemodynamic response to i.v. propranolol in patients with cirrhosis and portal hypertension. J Hepatol. 2009;51:279–87.CrossRefPubMedGoogle Scholar
  44. 44.
    Villanueva C, Aracil C, Colomo A, Hernandez-Gea V, Lopez-Balaguer JM, Alvarez-Urturi C, Torras X, et al. Acute hemodynamic response to beta-blockers and prediction of long-term outcome in primary prophylaxis of variceal bleeding. Gastroenterology. 2009;137:119–28.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Swiss Liver Center, HepatologyUniversity Clinic for Visceral Surgery and Medicine, Inselspital, University of BernBernSwitzerland

Personalised recommendations