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World J Hepatol. Aug 27, 2026; 18(8): 123580
Published online Aug 27, 2026. doi: 10.4254/wjh.123580
Effect of hepatic venous pressure gradient in different hepatic venous branches on assessing portal hypertension in cirrhotic patients
Yi-Fei Huang, Xiao-Qin Wu, Yi-Dong Yang, Bi-Lun Ke, Jin-Ni Luo, Bo-Yang Chang, Chu-Ren Zhou, Xiao-Li Huang, Xue-Mei Pan, Xue-Mei Lai, Li-Jun Zhang, Chun Wu, Bin Wu
Yi-Fei Huang, Xiao-Qin Wu, Yi-Dong Yang, Bi-Lun Ke, Jin-Ni Luo, Xiao-Li Huang, Xue-Mei Pan, Xue-Mei Lai, Li-Jun Zhang, Bin Wu, Department of Gastroenterology, Alcohol-related Liver Disease Center, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
Yi-Fei Huang, Xiao-Qin Wu, Yi-Dong Yang, Bi-Lun Ke, Jin-Ni Luo, Xiao-Li Huang, Xue-Mei Pan, Xue-Mei Lai, Li-Jun Zhang, Bin Wu, Guangdong Provincial Key Laboratory of Liver Disease Research, Guangzhou 510630, Guangdong Province, China
Bo-Yang Chang, Chu-Ren Zhou, Chun Wu, Department of Interventional Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
Co-first authors: Yi-Fei Huang and Xiao-Qin Wu.
Co-corresponding authors: Chun Wu and Bin Wu.
Author contributions: Huang YF and Wu B contributed to study concept and design; Huang YF and Wu XQ contributed equally to this manuscript as co-first authors; Wu XQ, Yang YD, Ke BL, Luo JN, Chang BY, Zhou CR, Huang XL, Pan XM, Lai XM, Zhang LJ, and Wu C contributed to acquisition of data and technique support; Huang YF contributed to drafting of the manuscript; Wu B and Wu C contributed to critical revision of the manuscript, and they contributed equally to this manuscript as co-corresponding authors. All authors read and approved the final manuscript.
AI contribution statement: No AI tools were used in the preparation of this manuscript.
Supported by Youth S&T Talent Support Program of Guangdong Provincial Association for Science and Technology (GDSTA), No. SKXRC2025129; Natural Science Foundation of Guangdong Province, No. 2025A1515012900; Scientific and Technological Planning Project of Guangzhou City, No. 2025A04J4250; and Cultivation Program for National Natural Science Foundation of The Third Affiliated Hospital of Sun Yat-sen University, No. 2025GZRPYQN04.
Institutional review board statement: The study protocol conformed to the ethical guidelines of the Declaration of Helsinki and was approved by the ethics committee of The Third Affiliated Hospital of Sun Yat-Sen University (approval No. RG2024-195-01).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: Deidentified individual participant data will not be shared. Researchers can apply for data by submitting a proposal to the corresponding author.
Corresponding author: Bin Wu, MD, PhD, Professor, Senior Researcher, Department of Gastroenterology, Alcohol-related Liver Disease Center, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe District, Guangzhou 510630, Guangdong Province, China.
wubin6@mail.sysu.edu.cn
Received: May 22, 2026
Revised: June 22, 2026
Accepted: July 16, 2026
Published online: August 27, 2026
Processing time: 88 Days and 13 Hours
BACKGROUND
Data regarding the hepatic venous pressure gradient (HVPG) in different hepatic venous branches remain insufficient.
AIM
To assess portal hypertension using HVPG measurements from the right HVPG (R-HVPG), middle HVPG (M-HVPG), and left HVPG (L-HVPG) hepatic veins, we conducted two sub-studies: Sub-study 1 evaluated the diagnostic value of R-HVPG, M-HVPG and L-HVPG, while sub-study 2 explored the correlation between M-HVPG and portal pressure gradient (PPG) to validate the results of sub-study 1.
METHODS
We prospectively enrolled 88 patients who underwent HVPG measurements in different hepatic venous branches in sub-study 1. Sub-group 2 covered 16 cirrhotic patients for M-HVPG and PPG comparisons (NCT06358092). Agreement was analyzed using intraclass correlation coefficients (ICC) and Bland-Altman plots.
RESULTS
In sub-study 1, M-HVPG demonstrated a significantly higher technical success rate (96.6%) than standard R-HVPG (83.0%) and L-HVPG (93.2%) (P < 0.05). After excluding 15 patients with collateral shunts in the R-HVPG, 73 were included in the final analysis. The mean R-HVPG, M-HVPG and L-HVPG were 16.43 (5.34), 16.98 (5.69) and 15.29 (5.22) mmHg, respectively, with no statistically significant difference (P > 0.05). Agreement between the R-HVPG and M-HVPG was substantial [ICC: 0.70 (0.56-0.80)], superior to the moderate R-HVPG/L-HVPG agreement [ICC: 0.56 (0.37-0.70)]. In sub-study 2, the M-HVPG and PPG showed substantial agreement [ICC: 0.80 (0.52-0.92)].
CONCLUSION
Our study demonstrates that M-HVPG achieves the highest technical success rate and superior agreement with R-HVPG, which supports the priority of technical feasibility of HVPG proposed in Baveno VII consensus. Furthermore, the strong correlation with PPG suggests that the M-HVPG potentially reflects accurate portal pressure. Consequently, M-HVPG may be considered a preferred alternative when R-HVPG is unfeasible or unreliable.
Core Tip: Middle hepatic venous pressure gradient (M-HVPG) achieves the highest technical success rate and superior agreement with right hepatic venous pressure gradient (HVPG) than that of left HVPG. M-HVPG potentially reflects accurate portal pressure. M-HVPG may be considered a preferred alternative when right HVPG is unfeasible or unreliable.
