Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 16, 2022; 10(14): 4460-4469
Published online May 16, 2022. doi: 10.12998/wjcc.v10.i14.4460
Correlation of pressure gradient in three hepatic veins with portal pressure gradient
Hao-Yu Wang, Qing-Kun Song, Zhen-Dong Yue, Lei Wang, Zhen-Hua Fan, Yi-Fan Wu, Cheng-Bin Dong, Yu Zhang, Ming-Ming Meng, Ke Zhang, Li Jiang, Hui-Guo Ding, Yue-Ning Zhang, Yong-Ping Yang, Fu-Quan Liu
Hao-Yu Wang, Department of Oncology, The 9th Clinical Medical College & Beijing Shijitan Hospital, Peking University, Beijing 100038, China
Qing-Kun Song, Division of Clinical Epidemiology and Evidence-Based Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
Zhen-Dong Yue, Lei Wang, Zhen-Hua Fan, Yi-Fan Wu, Cheng-Bin Dong, Yu Zhang, Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
Ming-Ming Meng, Department of Gastroenterology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
Ke Zhang, Li Jiang, Department of General Surgery, Beijing Ditan Hospital, Capital Medical University, Beijing 100102, China
Hui-Guo Ding, Yue-Ning Zhang, Department of Gastroenterology and Hepatology, Beijing You'an Hospital, Capital Medical University, Beijing 100069, China
Yong-Ping Yang, Department of Therapeutic Research for Liver Cancer, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China
Fu-Quan Liu, Department of Oncology, The 9th Clinical Medical College & Beijing Shijitan Hospital, Peking University, Beijing 100038, China
Author contributions: Liu FQ, Yue ZD, and Wang L contributed to the conception of the study; Liu FQ and Fan ZH performed the experiments; Wang HY, Meng MM, Zhang K, Jiang L, Ding HD, Zhang YN, and Yang YP contributed significantly to data analysis and manuscript preparation; Wang HY and Song QK performed the data analyses and wrote the manuscript; Wu YF, Dong CB, and Zhang Y helped perform the data analysis.
Supported by Special Scientific Research Project for Health Development in the Capital, No. 2018-1-2081; and Scientific Research Common Program of Beijing Municipal Commission of Education, No. KM201810025028.
Institutional review board statement: The study was reviewed and approved by the Beijing Shijitan Hospital Institutional Review Board.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author atlfuquan@aliyun.com.cn. Participants gave informed consent for data sharing. No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fu-Quan Liu, BCPS, MD, Director, Professor, Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tieyi Road, Yangfangdian, Haidian District, Beijing 100038, China. lfuquan@aliyun.com
Received: November 26, 2021
Peer-review started: November 26, 2021
First decision: January 11, 2022
Revised: January 25, 2022
Accepted: March 26, 2022
Article in press: March 26, 2022
Published online: May 16, 2022
Processing time: 168 Days and 7.8 Hours
Abstract
BACKGROUND

The liver is one of the most important organs in the human body, with functions such as detoxification, digestion, and blood coagulation. In terms of vascular anatomy, the liver is divided into the left and the right liver by the main portal vein, and there are three hepatic efferent veins (right, middle, and left) and two portal branches. Patients with impaired liver function have increased intrahepatic vascular resistance and splanchnic vasodilation, which may lead to an increase in the portal pressure gradient (PPG) and cause portal hypertension (PHT). In order to measure the increased pressure gradient of portal vein, the hepatic venous pressure gradient (HVPG) can be measured to reflect it in clinical practice. The accuracy of PPG measurements is directly related to patient prognosis.

AIM

To analyze the correlation between HVPG of three hepatic veins and PPG in patients with PHT.

METHODS

From January 2017 to December 2019, 102 patients with PHT who met the inclusion criteria were evaluated during the transjugular intrahepatic portosystemic shunt procedure and analyzed.

RESULTS

The mean HVPG of the middle hepatic vein was 17.47 ± 10.25 mmHg, and the mean HVPG of the right and left hepatic veins was 16.34 ± 7.60 and 16.52 ± 8.15 mmHg, respectively. The average PPG was 26.03 ± 9.24 mmHg. The correlation coefficient and coefficient of determination of the right hepatic vein, middle hepatic vein, and left hepatic vein were 0.15 and 0.02 (P = 0.164); 0.25 and 0.05 (P = 0.013); and 0.14 and 0.02 (P = 0.013), respectively. The mean wedged hepatic vein/venous pressure (WHVP) of the middle and left hepatic veins was similar at 29.71 ± 12.48 and 29.1 ± 10.91 mmHg, respectively, and the mean WHVP of the right hepatic vein was slightly lower at 28.01 ± 8.95 mmHg. The mean portal vein pressure was 34.11 ± 8.56 mmHg. The correlation coefficient and coefficient of determination of the right hepatic vein, middle hepatic vein, and left hepatic vein were 0.26 and 0.07 (P = 0.009); 0.38 and 0.15 (P < 0.001); and 0.26 and 0.07 (P = 0.008), respectively. The average free hepatic venous pressure (FHVP) of the right hepatic vein was lowest at 11.67 ± 5.34 mmHg, and the average FHVP of the middle and left hepatic veins was slightly higher at 12.19 ± 4.88 and 11.67 ± 5.34 mmHg, respectively. The average inferior vena cava pressure was 8.27 ± 4.04 mmHg. The correlation coefficient and coefficient of determination of the right hepatic vein, middle hepatic vein, and left hepatic vein were 0.30 and 0.09 (P = 0.002); 0.18 and 0.03 (P = 0.078); and 0.16 and 0.03 (P = 0.111), respectively.

CONCLUSION

Measurement of the middle hepatic vein HVPG could better represent PPG. Considering the high success rate of clinical measurement of the right hepatic vein, it can be the second choice.

Keywords: Portal hypertension; Portal pressure gradient; Hepatic venous pressure gradient; Free hepatic venous pressure

Core Tip: Portal hypertension (PHT) is a serious complication of various liver diseases, including cirrhosis, with a high mortality rate. To improve its prognosis, methods to accurately measure the magnitude of the increase in portal pressure are needed. This study compared and analyzed the relationship between hepatic venous pressure gradient of three hepatic veins and portal pressure gradient in 102 patients with PHT, aiming to find out the hepatic vein pressure gradient branch that best represents the patients’ actual portal vein pressure gradient in clinic.