Correlation and consistency analysis between various indirect portal pressure gradients and actual portal pressure gradient.

OBJECTIVE

To evaluate the correlation and consistency between hepatic venous pressure gradient(F-HVPG) calculated as the wedged hepatic venous pressure (WHVP) minus free hepatic venous pressure (FHVP), I-HVPG calculated as WHVP minus inferior vena cava pressure (IVCP) in the hepatic segment, and portal pressure gradient (PPG).

METHODS

Data were collected from 112 patients with portal hypertension undergoing transjugular intrahepatic portosystemic shunt (TIPS) along with HVPG measurement. FHVP, IVCP, WHVP, and portal venous pressure (PVP) were collected intraoperatively. Pearson's correlation and Bland-Altman method were used to assess correlation and consistency.

RESULTS

A total of 112 patients were retrospectively collected. The correlation coefficient (r) values (p < 0.001) between FHVP and IVCP, WHVP and PVP, F-HVPG and I-HVPG, F-HVPG and PPG, I-HVPG and PPG were 0.835, 0.717, 0.946, 0.667 and 0.698, respectively; the determination coefficient (R) values were 0.697, 0.514, 0.895, 0.445 and 0.487, respectively. Bland-Altman plots showed that F-HVPG and I-HVPG had the narrowest 95% limits of agreement. Among patients with FHVP-IVCP > 2 mmHg, the (r) values (p < 0.05) between F-HVPG and I-HVPG, F-HVPG and PPG, I-HVPG and PPG were 0.907, 0.648 and 0.807, respectively; the (R) values were 0.822, 0.420 and 0.651, respectively. Bland-Altman plots showed that I-HVPG had the narrower 95% limits of agreement with PPG.

CONCLUSION

F-HVPG and I-HVPG demonstrated high correlation and consistency. I-HVPG consistently correlates more closely with PPG than F-HVPG, both in the overall cohort and in patients with FHVP-IVCP > 2 mmHg. These results suggest that I-HVPG may serve as a more reliable alternative. Due to the significant underestimation of the PPG, HVPG measurement should not be used to exclude patients from a TIPS intervention.