Session Title: Category 2b. CIRRHOSIS AND ITS COMPLICATIONS: b. CLINICAL ASPECTS
Presentation Date: Apr 15, 2010
REPRODUCIBILITY AND RELIABILITY OF THE HEPATIC VENOUS PRESSURE GRADIENT (HVPG) MEASUREMENT IN PATIENTS WITH CIRRHOSIS IS HIGHER USING THE BALLOON COMPARED TO THE STRAIGHT CATHETER
A. Zipprich*, M. Winkler, T. Seufferlein, M.M. Dollinger
First Department of Internal Medicine, Martin-Luther-University Halle, Halle, Germany. *email@example.com
HVPG (i.e. the difference between wedge hepatic [WHVP] and free hepatic venous pressure [FHVP]) is used as an estimation of portal pressure and of great importance in the management of patients with cirrhosis. Reduction of HVPG is correlated with a reduced risk of development of portal hypertension related complications, mainly variceal bleeding. Two different methods are available (straight and balloon catheter) and although the balloon catheter is considered more reproducible and reliable these two procedures were never compared directly. The aim of the study was to compare the two methods for HVPG assessment regarding reproducibility and reliability.
Methods: In 47 patients with cirrhosis (alcoholic cirrhosis: n=28; HVPG [mean±SD]: 14.7±7.2 mm Hg) repeated measurements of HVPG was done using the straight (3 times) and the balloon catheter (3 times) during the same procedure to investigate the reproducibility. In another 29 patients (alcoholic cirrhosis: n=25; WHVP [mean±SD]: 29.89±7.9 mm Hg; portal pressure: 30.4±7.1 mm Hg), WHVP was measured using the straight or the balloon catheter followed by a direct measurement of the portal pressure during TIPS insertion to investigate the reliability. For all measurements, variation coefficient and intraclass correlation coefficient were calculated.
Results: Variation coefficients for the balloon catheter were 0.07, 0.02, and 0.06 for HVPG, WHVP, and FHVP, respectively. Variation coefficients for the straight catheter were 0.17 (HVPG), 0.06 (WHVP), and 0.07 (FHVP), and significantly higher for HVPG and WHVP (p< 0.001) compared with the balloon catheter. When comparing the WHVP measurements with the portal venous pressure, the calculated intraclass correlation coefficient was 0.72 (p=0.004) using the balloon and 0.58 (p=0.011) using the straight catheter.
Conclusion: Reproducibility and reliability of the HVPG measurement was higher using the balloon catheter, which should be the preferred procedure to measure HVPG. The significant greater variation coefficient of the straight catheter may become clinically relevant, if this method is used to perform repeated measurements during the management of cirrhotic patients.