+ Resolve Article
+ Follow Us
Follow on FacebookFollow on Facebook
Follow on TwitterFollow on Twitter

+ Translate
+ Subscribe to Site Feed
GeoScience Most Shared ContentMost Shared Content

Right atrial pressure is not adequate to calculate portal pressure gradient in cirrhosis: a clinical-hemodynamic correlation study

, : Right atrial pressure is not adequate to calculate portal pressure gradient in cirrhosis: a clinical-hemodynamic correlation study. Hepatology 51(6): 2108-2116

Hepatic venous pressure gradient (HVPG), the difference between wedge and free hepatic venous pressure, is the preferred method for estimating portal pressure. However, it has been suggested that hepatic atrial pressure gradient (HAPG)--the gradient between wedge hepatic venous pressure and right atrial pressure (RAP)--might better reflect variceal hemodynamics. The aim of this study was to (1) investigate whether HAPG with nonselective beta-blockers correlates with prognosis in cirrhotic patients with portal hypertension at baseline and during treatment; (2) compare the prognostic value of HAPG with that of HVPG; and (3) investigate the agreement between portoatrial gradient (PAG) and portocaval gradient (PCG) in patients with transjugular intrahepatic portosystemic shunt (TIPS). We included 154 cirrhotic patients with varices with a complete hemodynamic study at baseline and on chronic treatment for primary (n = 71) or secondary (n = 83) prophylaxis for bleeding and 99 patients with TIPS. All patients were followed for up to 2 years; portal hypertensive-related bleeding and bleeding-free survival were analyzed. HVPG was equal or lower than HAPG in all patients (-3.2 mm Hg; P < 0.001). Agreement between HAPG and HVPG was modest, especially in patients with increased intra-abdominal pressure. One hundred two patients were HVPG nonresponders and 52 patients were HVPG responders to nonselective beta-blockers, whereas 101 patients were HAPG nonresponders and 53 patients were HAPG responders (k = 0.610). HVPG response revealed an excellent predictive value for bleeding risk and bleeding-free survival; HAPG did not. In our TIPS patients, 20% had a PCG < or =12 mm Hg and a PAG >12 mm Hg, which may have induced unnecessary overdilation of the TIPS. The excellent prognostic information provided by HVPG response to drug therapy is lost if HAPG response is considered. RAP should not be used for the calculation of portal pressure gradient in patients with cirrhosis.


PMID: 20512998

DOI: 10.1002/hep.23612

Other references

Sturup, H., 1952: Coronary thrombosis and other forms of circulatory insufficiency coinciding with cerebral apoplexy. In a clinical series of 100 patients with cerebral apoplexy, 6 definite cases of fresh coronary thrombosis were found. The incidence of coronary thrombosis in autopsy-proven apoplexy was 13.5%. An additional 7 patients exhibited heart disease with...

Tosepu, R., 2017: The Appropriate Rainfall to Development of Zika Virus: An Indonesian Case. Ethiopian Journal of Health Sciences 27(1): 104-105

Peer, L.A.; Walker, J.C.; Va.D.Yn.J., 1950: Progress in otolaryngology. Summaries of the bibliographic material available in the field of otolaryngology for 1947 and 1948; plastic surgery. A.M.A. Archives of Otolaryngology 52(6): 964-992

Lopez Goomez, J.J., 1960: Talla media de la sardina desembarcada en Castellon. Reunion sobre Productividad y Pesquerias Barcelona, 4: 87-88

Andreassen, I., 1998: Prevention--many new plans--no money. Interview by Marit Fonn. Tidsskriftet Sykepleien 85(21): 8-12

Schippers, S.; Müller, A.; Ricz, S.; Bannister, M.E.; Dunn, G.H.; Bozek, J.; Schlachter, A.S.; Hinojosa, G.; Cisneros, C.; Aguilar, A.; Covington, A.M.; Gharaibeh, M.F.; Phaneuf, R.A., 2002: Experimental link of photoionization of Sc2+ to photorecombination of Sc3+: an application of detailed balance in a unique atomic system. The principle of microscopic time reversal of physical processes, detailed balance, is widely used and depended upon in the theoretical community as a connection between photorecombination (PR) and photoionization (PI). This paper reports on a nov...

Adair, S.M., 2005: Where are we going? How do we get there?. Pediatric Dentistry 27(3): 183-183

Sheikhan, Z.; Ozgoli, G.; Azar, M.; Alavimajd, H., 2015: Domestic violence in Iranian infertile women. Millions of men and women suffer from infertility worldwide. In many cultures, infertile women are at risk of social and emotional problems. Infertility may affect the public health in many countries. Domestic violence is the intentional use of ph...

Pshenichnyi, A.E.; Zakharov, A.A., 1972: Effect of the application of mineral fertilizers in spring on grain yield and quality of spring wheat. In pot trials with spring wheat in 1969-70 on chernozem soil, application of 45 kg N/ha slightly decreased grain yield, but markedly increased protein and gluten contents in the grain. Application of 30 kg P2O5/ha markedly increased yield, but dec...

Jankela, J.; Baranovská, M.; Gazo, M.L., 1993: Nitrogen excretion in Japanese quail during protein depletion and repletion. The influence of protein depletion and repletion on the excretion of uric acid, urea, creatinine and free arginine as well as on the activities of xanthine dehydrogenase and arginase in Japanese quail was studied. Adult cockerels normally fed unti...