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Hepatic venous pressure gradient

Dong Ho Lee, Jhii-Hyun Ahn, Jin Wook Chung, Young Ju Kim, Seung-Whan Cha, Moon Young Kim, Soon Koo Baik
BACKGROUND & AIMS: To investigate prognostic value of varices on CT and redefine surrogate criteria for clinically significant portal hypertension (CSPH). METHOD: We retrospectively enrolled 241 patients with compensated cirrhosis who underwent hepatic venous pressure gradient (HVPG) measurement from 2008 to 2013. Using CT and upper endoscopy findings obtained within 3 months from HVPG measurement, patients were classified into three groups: presence of standard surrogate for CSPH, defined as presence of varices on upper endoscopy and/or splenomegaly associated with thrombocytopenia (Group 1, n=139); varices on CT without standard surrogate for CSPH (Group 2, n=41); and free from both (Group 3, n=61)...
June 14, 2018: Journal of Gastroenterology and Hepatology
Tsuyoshi Ishikawa, Ryo Sasaki, Tatsuro Nishimura, Takashi Matsuda, Masaki Maeda, Takuya Iwamoto, Issei Saeki, Isao Hidaka, Taro Takami, Isao Sakaida
AIM: To compare the clinical characteristics of patients with hepatic encephalopathy (HE) and those with gastric varices (GV) before and after balloon-occluded retrograde transvenous obliteration (BRTO). METHODS: Eighty cirrhotic patients who underwent BRTO, including 42 men and 38 women, and whose mean age was 68.0 years, comprised the HE (n = 18) and GV (n = 62) groups. The patients' data before and 1 month after BRTO were analyzed. RESULTS: Before BRTO, the groups did not differ in their portal flow volume (PFV) and hepatic venous pressure gradient (HVPG)...
June 7, 2018: Hepatology Research: the Official Journal of the Japan Society of Hepatology
Walid Ismail Ellakany, Khaled Mahmoud MoheyEldin, Pietro Invernizzi, Ali Mahmoud ElKady, Hossam Eldin Fathy Abou Elkheir, Reham Abdel Haleem Abo Elwafa, Ahmed Ellakany
INTRODUCTION: Cirrhosis as a pathological term has some criteria known to be common in all cases of liver cirrhosis. Esophageal varices are portosystemic collaterals arising in the submucosa of the lower esophagus because of portal hypertension. Portal hypertension is defined as hepatic venous pressure gradient greater than 5 mmHg that arises often as a sequelae of mesenchymal dysfunction in a cirrhotic liver. This study was carried out on 120 personnel divided into three groups: group A included 50 cases of liver cirrhosis with esophageal varices, group B consisted of 50 cases of cirrhosis without esophageal varices, and group C had 20 healthy volunteers a control group...
June 5, 2018: European Journal of Gastroenterology & Hepatology
Mona Haj, Don C Rockey
PURPOSE OF REVIEW: The current review aims to explain the different systems available to clinicians for predicting clinical outcomes in patients with cirrhosis. RECENT FINDINGS: Cirrhosis is the final stage of chronic liver disease and is associated with high morbidity and mortality. The most commonly utilized tools to predict outcomes in patients with cirrhosis include the following: assessing severity of portal hypertension using hepatic venous pressure gradient (HVPG) measurements, using scoring systems such as the Model for End-stage Liver Disease (MELD) and Child-Pugh-Turcotte (CPT) scores, and recently, clinical staging systems based on cirrhosis-related clinical complications...
July 2018: Current Opinion in Gastroenterology
Mrinal M Patnaik, Patrick S Kamath, Douglas A Simonetto
Clinical Case A 51 year old Caucasian male was referred for evaluation of variceal bleeding. Laboratory tests were remarkable for mild thrombocytopenia and moderate alkaline phosphatase elevation. Synthetic liver function was well preserved. Abdominal computed tomography scan revealed moderate splenomegaly, gastric varices, and normal hepatic contour. A transjugular liver biopsy was performed revealing findings of nodular regenerative hyperplasia (NRH) with no significant fibrosis or necroinflammatory activity...
May 11, 2018: Journal of Hepatology
Kayvan Mohkam, Agnès Rode, Benjamin Darnis, Anne-Frédérique Manichon, Loïc Boussel, Christian Ducerf, Philippe Merle, Mickaël Lesurtel, Jean-Yves Mabrut
BACKGROUND: The impact of portal hemodynamic variations after portal vein embolization on liver regeneration remains unknown. We studied the correlation between the parameters of hepatic venous pressure measured before and after portal vein embolization and future hypertrophy of the liver remnant after portal vein embolization. METHODS: Between 2014 and 2017, we reviewed patients who were eligible for major hepatectomy and who had portal vein embolization. Patients had undergone simultaneous measurement of portal venous pressure and hepatic venous pressure gradient before and after portal vein embolization by direct puncture of portal vein and inferior vena cava...
May 9, 2018: Surgery
Felix Piecha, Mattias Mandorfer, Teresa Peccerella, Ann-Kathrin Ozga, Tanja Poth, Anna Vonbank, Helmut Karl Seitz, Vanessa Rausch, Thomas Reiberger, Sebastian Mueller
Liver stiffness (LS) as measured by transient elastography is increasingly used to non-invasively assess liver fibrosis. However, LS is efficiently modulated by confounders like arterial and portal pressure (PP). We here study the effect of acute hemodynamic changes on LS (measured by µFibroscan) in a rodent model of cirrhosis in response to pharmacological modulation of PP by losartan, NO-donors and propranolol. Additionally, changes of LS and the hepatic venous pressure gradient (HVPG) under propranolol therapy were assessed with regard to clinical outcomes in a human cohort of n=38 cirrhotic patients...
May 10, 2018: American Journal of Physiology. Gastrointestinal and Liver Physiology
Phil Meister, Alexander Dechêne, Matthias Büchter, Julia Kälsch, Guido Gerken, Ali Canbay, Christoph Jochum
OBJECTIVES: Spleen stiffness (SS) correlates with liver stiffness (LS) and hepatic venous pressure gradient. The latter is currently the most accurate predictor of hepatic decompensation. Our study aims to check whether SS has a similar predictive capability, while being an easy-to-perform noninvasive test in a real-life patient cohort. METHODS: Concomitantly, 210 successive patients were examined and received liver and SS measurements and a standard laboratory...
April 17, 2018: Journal of Clinical Gastroenterology
Laurent Spahr, Nicolas Goossens, Flavie Furrer, Melissa Dupuis, Sandrine Vijgen, Laure Elkrief, Emiliano Giostra, Laura Rubbia-Brandt, Jean-Louis Frossard
BACKGROUND: Increased hepatic venous pressure gradient (HVPG) plays a role in the clinical manifestations of alcoholic hepatitis (AH). The evolution of HVPG and the influence of alcohol use in the intermediate term are unclear. AIM: The aim of this study was to explore HVPG modifications following AH taking into consideration alcohol use and clinical manifestations. PATIENTS AND METHODS: Patients with AH (n=37; age 52 years; model for end-stage liver disease: 18...
April 30, 2018: European Journal of Gastroenterology & Hepatology
Martin Chong Wang, Franziska Wandrer, Jerome Schlué, Torsten Voigtländer, Tim Oliver Lankisch, Michael Peter Manns, Heike Bantel, Thomas von Hahn
AIM: Acute liver failure (ALF) is a syndrome of severe liver injury that may need urgent liver transplantation and is associated with significant risk of death. Early outcome prediction and further possibilities to increase accuracy of prognosis scores are important. METHODS: We examined 30 patients with ALF, according to the novel criteria of the Intractable Hepato-Biliary Diseases Study Group, who underwent transjugular liver biopsy (TJLB) and investigated the relevance of histology for correct diagnosis and etiology...
May 4, 2018: Hepatology Research: the Official Journal of the Japan Society of Hepatology
Tianqi Wang, Fuyou Liang, Zunqiang Zhou, Xiaolong Qi
Hepatic venous pressure gradient (HVPG) is a widely employed surrogate of portal pressure gradient (PPG) in the diagnosis of portal hypertension (PHT). However, little is known about how HVPG measurement is affected by the complex vascular changes associated with PHT. In this study, we employed a computational method to quantitatively evaluate the sensitivity of HVPG measurement to various vascular factors involved in the development of sinusoidal PHT, aiming to provide a theoretical reference to guide the clinical application of HVPG measurement...
June 1, 2018: Computers in Biology and Medicine
Abhijit Chougule, Archana Rastogi, Rakhi Maiwall, Chhagan Bihari, Vikrant Sood, Shiv Kumar Sarin
BACKGROUND AND AIMS: Non-cirrhotic portal fibrosis (NCPF) is a clinical disorder characterized by features of portal hypertension in the absence of significant fibrosis. It is one of the commonest causes of portal hypertension in India. This study aimed to analyze histomorphological spectrum of NCPF in detail. METHODS AND RESULTS: There were 67 specimens from 66 patients which included 43 (65.2%) male and 23 (34.8%) female patients with a mean age of 31 years (range: 7-61 years)...
March 2018: Hepatology International
Reyes Roca, Pablo Esteban, Pedro Zapater, María-Del-Mar Inda, Anna Lucia Conte, Laura Gómez-Escolar, Helena Martínez, José F Horga, José M Palazon, Ana M Peiró
The present study was designed to investigate the functional status of β2 adrenoceptors (β2AR) in two models of chronic inflammatory disease: liver cirrhosis (LC) and osteoarthritis (OA). The β2AR gene contains three single nucleotide polymorphisms at amino acid positions 16, 27 and 164. The aim of the present study was to investigate the potential influence of lymphocyte β2AR receptor functionality and genotype in LC and OA patients. Blood samples from cirrhotic patients (n=52, hepatic venous pressure gradient 13±4 mmHg, CHILD 7±2 and MELD 11±4 scores), OA patients (n=30, 84% Kellgren‑Lawrence severity 4 grade, 14% knee replacement joint) and healthy volunteers as control group (n=26) were analyzed...
June 2018: Molecular Medicine Reports
Audrey Payancé, Gilberto Silva-Junior, Julien Bissonnette, Marion Tanguy, Blandine Pasquet, Cristina Levi, Olivier Roux, Ouardia Nekachtali, Anna Baiges, Virginia Hernández-Gea, Cédric Laouénan, Didier Lebrec, Miguel Albuquerque, Valérie Paradis, Richard Moreau, Dominique Valla, François Durand, Chantal M Boulanger, Juan-Carlos Garcia-Pagan, Pierre-Emmanuel Rautou
Microvesicles (MVs) are extracellular vesicles released by cells following activation or apoptosis. Some MV subpopulations augment with cirrhosis severity and contribute to portal hypertension. This study aimed at determining if plasma MV levels can estimate the presence of hepatic venous pressure gradient (HVPG) ≥10 mm Hg and predict mortality in patients with advanced chronic liver disease. All patients with severe fibrosis or cirrhosis undergoing liver catheterization between 2013 and 2015 at two centers were prospectively included...
March 30, 2018: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
E Wisén, K Svennerholm, L S Bown, E Houltz, M Rizell, S Lundin, S-E Ricksten
BACKGROUND: Various methods are used to reduce venous blood pressure in the hepato-splanchnic circulation, and hence minimise blood loss during liver surgery. Previous studies show that combination of vasopressin and nitroglycerin reduces portal pressure and flow in patients with portal hypertension, and in this study we investigated this combination in patients with normal portal pressure. METHOD: In all, 13 patients were studied. Measurements were made twice to confirm baseline (C1 and BL), during vasopressin infusion 4...
March 26, 2018: Acta Anaesthesiologica Scandinavica
Chong Hyun Suh, Kyung Won Kim, Seong Ho Park, Seung Soo Lee, Ho Sung Kim, Sree Harsha Tirumani, Jong Gu Lee, Junhee Pyo
OBJECTIVE: To qualify shear wave elastography (SWE) as a biomarker for clinically significant portal hypertension (CSPH) beyond proof of concept, we aimed to accumulate and summarize the current evidence through systematic review and meta-analysis. MATERIALS AND METHODS: A computerized literature search was performed to identify studies from MEDLINE and EMBASE up to February 9, 2017. Studies on the diagnostic performance of liver stiffness measurements using SWE for CSPH with hepatic venous pressure gradient (HVPG) as the reference standard were included...
May 2018: AJR. American Journal of Roentgenology
Yujen Tseng, Lili Ma, Tiancheng Luo, Xiaoqing Zeng, Na Li, Yichao Wei, Ji Zhou, Feng Li, Shiyao Chen
Portal hypertension secondary to liver cirrhosis may cause a number of life-threatening complications. The rupture of gastroesophageal varices is associated with a high mortality rate of 15-30%. Hepatic venous pressure gradient (HVPG) is an accurate reflection of disease severity, however this can only be assessed via an invasive interventional procedure. The aim of the present study was to explore a non-invasive method based on 3D computed tomography (CT) volume rendering technology to accurately predict HVPG...
April 2018: Experimental and Therapeutic Medicine
R Schwarzer, D Kivaranovic, R Paternostro, M Mandorfer, T Reiberger, M Trauner, M Peck-Radosavljevic, A Ferlitsch
BACKGROUND: Sequential measurements of hepatic venous pressure gradient (HVPG) are used to assess the haemodynamic response to nonselective betablockers (NSBBs) in patients with portal hypertension. AIMS: To assess the rates of HVPG response to different doses of carvedilol. METHODS: Consecutive patients with cirrhosis undergoing HVPG-guided carvedilol therapy for primary prophylaxis of variceal bleeding between 08/2010 and 05/2015 were retrospectively included...
April 2018: Alimentary Pharmacology & Therapeutics
Jonel Trebicka
Does transjugular intrahepatic portosystemic shunt stent (TIPS) improve survival in a subgroup of patients? Yes. TIPS nearly halves portal pressure and increases the effective blood volume. In cases of acute variceal hemorrhage and with a high risk of treatment failure, defined as either hepatic venous pressure gradient higher than 20 mm Hg, Child B with active bleeding at the endoscopy, or Child C with less than 14 points, early or preemptive placement of TIPS (within 72 hours) improves survival. Also, in suitable patients with intractable or refractory ascites, TIPS improves survival if placed early in the course of treatment...
February 2018: Seminars in Liver Disease
Huijing Yao, Chunqing Zhang
BACKGROUND: Randomized controlled trials (RCTs) showed inconsistent results regarding the efficacy of angiotensin II receptor blockers (ARBs) on portal pressure as indicated by hepatic venous pressure gradient (HVPG). METHODS: A meta-analysis of RCTs was performed to evaluate the influence of ARBs treatment on HVPG. PubMed, Embase, and Cochrane's Library were searched for relevant RCTs. A fixed or a randomized effect model was used to pool the results according the heterogeneity...
February 22, 2018: Irish Journal of Medical Science
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