Impact of catheter tip to hepatic vein ostium distance on the validity and prognostication of hepatic venous pressure gradient in cirrhosis
Abstract Hepatic venous pressure gradient (HVPG) is an accurate measure of portal hypertension in cirrhosis. However, the effect of catheter tip distance from hepatic vein ostium (HVO) on HVPG is unknown. We performed a retrospective study on 228 patients with 307 HVPGs in our institution. The objec...
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Nature Portfolio
2023-10-01
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| Series: | Scientific Reports |
| Online Access: | https://doi.org/10.1038/s41598-023-44016-7 |
| _version_ | 1797576724206059520 |
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| author | Hiang Keat Tan Alfred Bingchao Tan Kevin Kim Jun Teh Apoorva Gogna Chow Wei Too Sum Leong Jason Pik Eu Chang |
| author_facet | Hiang Keat Tan Alfred Bingchao Tan Kevin Kim Jun Teh Apoorva Gogna Chow Wei Too Sum Leong Jason Pik Eu Chang |
| author_sort | Hiang Keat Tan |
| collection | DOAJ |
| description | Abstract Hepatic venous pressure gradient (HVPG) is an accurate measure of portal hypertension in cirrhosis. However, the effect of catheter tip distance from hepatic vein ostium (HVO) on HVPG is unknown. We performed a retrospective study on 228 patients with 307 HVPGs in our institution. The objectives of this study were to assess the effect of catheter position on the validity of HVPG and its prognostication in cirrhosis. In this study, free hepatic vein pressure (FHVP) was considered optimal when difference between FHVP and inferior vena cava pressure was ≤ 2 mmHg. HVPG progressively decreased (p < 0.001) when measured at increasing distance from HVO due to an increasing FHVP (p = 0.036) but an unchanged wedged hepatic vein pressure (p = 0.343). Catheter tip distance > 5 to ≤ 8 cm [odds ratio {OR} 0.16 (95% CI 0.05–0.47), p = 0.001] and > 8 cm [OR 0.14 (95% CI 0.04–0.47), p = 0.002] compared to ≤ 3 cm from HVO were independent predictors of not achieving optimal FHVP. Baseline HVPG ≥ 16 mmHg was strongly associated with deaths due to cirrhosis and liver transplantation for end-stage liver disease compared to HVPG < 16 mmHg when FHVP was optimal (p < 0.001) but not when it was suboptimal (p = 0.359). Our study showed that FHVP is spuriously elevated when measured at > 5 cm from HVO, resulting in inaccurately low HVPG. |
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| institution | Directory Open Access Journal |
| issn | 2045-2322 |
| language | English |
| last_indexed | 2024-03-10T21:56:51Z |
| publishDate | 2023-10-01 |
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| spelling | doaj.art-c4b14a43ed7e437099e764e0eadf82262023-11-19T13:06:00ZengNature PortfolioScientific Reports2045-23222023-10-0113111210.1038/s41598-023-44016-7Impact of catheter tip to hepatic vein ostium distance on the validity and prognostication of hepatic venous pressure gradient in cirrhosisHiang Keat Tan0Alfred Bingchao Tan1Kevin Kim Jun Teh2Apoorva Gogna3Chow Wei Too4Sum Leong5Jason Pik Eu Chang6Department of Gastroenterology and Hepatology, Singapore General HospitalDepartment of Vascular and Interventional Radiology, Singapore General HospitalDepartment of Gastroenterology and Hepatology, Singapore General HospitalDepartment of Vascular and Interventional Radiology, Singapore General HospitalDepartment of Vascular and Interventional Radiology, Singapore General HospitalDepartment of Vascular and Interventional Radiology, Singapore General HospitalDepartment of Gastroenterology and Hepatology, Singapore General HospitalAbstract Hepatic venous pressure gradient (HVPG) is an accurate measure of portal hypertension in cirrhosis. However, the effect of catheter tip distance from hepatic vein ostium (HVO) on HVPG is unknown. We performed a retrospective study on 228 patients with 307 HVPGs in our institution. The objectives of this study were to assess the effect of catheter position on the validity of HVPG and its prognostication in cirrhosis. In this study, free hepatic vein pressure (FHVP) was considered optimal when difference between FHVP and inferior vena cava pressure was ≤ 2 mmHg. HVPG progressively decreased (p < 0.001) when measured at increasing distance from HVO due to an increasing FHVP (p = 0.036) but an unchanged wedged hepatic vein pressure (p = 0.343). Catheter tip distance > 5 to ≤ 8 cm [odds ratio {OR} 0.16 (95% CI 0.05–0.47), p = 0.001] and > 8 cm [OR 0.14 (95% CI 0.04–0.47), p = 0.002] compared to ≤ 3 cm from HVO were independent predictors of not achieving optimal FHVP. Baseline HVPG ≥ 16 mmHg was strongly associated with deaths due to cirrhosis and liver transplantation for end-stage liver disease compared to HVPG < 16 mmHg when FHVP was optimal (p < 0.001) but not when it was suboptimal (p = 0.359). Our study showed that FHVP is spuriously elevated when measured at > 5 cm from HVO, resulting in inaccurately low HVPG.https://doi.org/10.1038/s41598-023-44016-7 |
| spellingShingle | Hiang Keat Tan Alfred Bingchao Tan Kevin Kim Jun Teh Apoorva Gogna Chow Wei Too Sum Leong Jason Pik Eu Chang Impact of catheter tip to hepatic vein ostium distance on the validity and prognostication of hepatic venous pressure gradient in cirrhosis Scientific Reports |
| title | Impact of catheter tip to hepatic vein ostium distance on the validity and prognostication of hepatic venous pressure gradient in cirrhosis |
| title_full | Impact of catheter tip to hepatic vein ostium distance on the validity and prognostication of hepatic venous pressure gradient in cirrhosis |
| title_fullStr | Impact of catheter tip to hepatic vein ostium distance on the validity and prognostication of hepatic venous pressure gradient in cirrhosis |
| title_full_unstemmed | Impact of catheter tip to hepatic vein ostium distance on the validity and prognostication of hepatic venous pressure gradient in cirrhosis |
| title_short | Impact of catheter tip to hepatic vein ostium distance on the validity and prognostication of hepatic venous pressure gradient in cirrhosis |
| title_sort | impact of catheter tip to hepatic vein ostium distance on the validity and prognostication of hepatic venous pressure gradient in cirrhosis |
| url | https://doi.org/10.1038/s41598-023-44016-7 |
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