Hepatic venous pressure gradient (HVPG) measurement represents the gold standard to
evaluate the presence of portal hypertension (PH), defined by HVPG >5 mmHg [
[1]
]. Up to HVPG values <10 mmHg, patients have a negligible risk of developing PH-related
complications of advanced chronic liver disease (ACLD). Conversely in those with HVPG
>10 mmHg, which delineates clinically significant portal hypertension (CSPH), the
risk of developing varices, variceal bleeding, ascites, spontaneous bacterial peritonitis,
hepatorenal syndrome and hepatic encephalopathy increases exponentially [
- de Franchis R.
- Bosch J.
- Garcia-Tsao G.
- Reiberger T.
- et al.
Baveno VII - renewing consensus in portal hypertension.
J Hepatol. 2022; 76 (AprEpub 2021 Dec 30. Erratum in: J Hepatol. 2022 Apr 14;: PMID: 35120736): 959-974https://doi.org/10.1016/j.jhep.2021.12.022
[2]
]. HVPG measurement is, therefore, critical to monitor ACLD progression, stratify patient's
prognosis, and assess effects of pre-emptive or therapeutic interventions. HVPG, however,
is an indirect method of PH measurement, being performed outside the portal vein system.
It reflects portal pressure gradient (PPG) and is highly reliable in sinusoidal forms
of PH (e.g. viral- and alcohol-related cirrhosis), but not in pre-sinusoidal ones
[
[3]
]. This, indeed, is the case of porto-sinusoidal vascular disease (PSVD) [
- Seijo S.
- Reverter E.
- Miquel R.
- et al.
Role of hepatic vein catheterisation and transient elastography in the diagnosis of
idiopathic portal hypertension.
Dig Liver Dis. 2012; 44 (OctEpub 2012 Jun 19. PMID: 22721839): 855-860https://doi.org/10.1016/j.dld.2012.05.005
[4]
], characterized by histologic lesions encompassing portal venules and sinusoids, which
is becoming increasingly recognized representing 3–7% of cases of PH in Western countries
[
- De Gottardi A.
- Rautou P.E.
- Schouten J.
- et al.
Porto-sinusoidal vascular disease: proposal and description of a novel entity.
Lancet Gastroenterol Hepatol. 2019; 4 (MayPMID: 30957754): 399-411https://doi.org/10.1016/S2468-1253(19)30047-0
[5]
,
- Barge S.
- Grando V.
- Nault J.C.
- et al.
Prevalence and clinical significance of nodular regenerative hyperplasia in liver
biopsies.
Liver Int. 2016; 36 (JulEpub 2015 Oct 19. PMID: 26415006): 1059-1066https://doi.org/10.1111/liv.12974
[6]
. This disease interests the pre-sinusoidal site, rendering HVPG measurement unreliable,
even in those patients with clear-cut clinical signs of CSPH (i.e. gastro-esophageal
varices and porto-systemic collaterals) [
[4]
].- De Gottardi A.
- Rautou P.E.
- Schouten J.
- et al.
Porto-sinusoidal vascular disease: proposal and description of a novel entity.
Lancet Gastroenterol Hepatol. 2019; 4 (MayPMID: 30957754): 399-411https://doi.org/10.1016/S2468-1253(19)30047-0
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References
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- Porto-sinusoidal vascular disease: proposal and description of a novel entity.Lancet Gastroenterol Hepatol. 2019; 4 (MayPMID: 30957754): 399-411https://doi.org/10.1016/S2468-1253(19)30047-0
- Prevalence and clinical significance of nodular regenerative hyperplasia in liver biopsies.Liver Int. 2016; 36 (JulEpub 2015 Oct 19. PMID: 26415006): 1059-1066https://doi.org/10.1111/liv.12974
- Micronodular transformation (nodular regenerative hyperplasia) of the liver: a report of 64 cases among 2,500 autopsies and a new classification of benign hepatocellular nodules.Hepatology. 1990; 11: 787-797
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Article Info
Publication History
Published online: November 11, 2022
Accepted:
October 19,
2022
Received:
October 13,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
