Journal of vascular and interventional radiology : JVIR · 2024
Fine-Needle Portosystemic Pressure Gradient as a Reference for Portal Hypertension in Patients with Intrahepatic Venovenous Shunt: A Prospective Study.
СтатьяСравнительное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Ma Li, Fang Ying, Zhang Wen, Liu Yaozu, Zhou Yongjie, Yu Jiaze, Zhou Xin, Zhang Zihan, Yang Minjie, Chen Shiyao, Wang Jian, Yan Zhiping, Luo Jianjun, Ma Jingqin
Аннотация
PURPOSE: To evaluate the consistency and agreement between portal venous pressure measured by a fine needle (FN-PVP), direct portal vein catheterization (D-PVP), and wedged hepatic vein balloon occlusion (W-HVP) in patients with decompensated cirrhosis and intrahepatic venovenous shunts (IHVSs).
MATERIALS AND METHODS: One hundred fifty-six consecutive patients planning to receive a transjugular intrahepatic portosystemic shunt in the authors' center were screened for study participation. The FN-PVP, D-PVP, and W-HVP were assessed for consistency by Pearson coefficient (r), linear regression coefficient (R2), and intraclass correlation coefficient (ICC) and for disagreement (error exceeding 20% of D-PVP) by the Bland-Altman method.
RESULTS: Of 92 eligible patients, FN-PVP was successfully obtained in 37 (40.2%) with IHVS, with no puncture-related adverse events. In these patients, there were significant differences between W-HVP and D-PVP (-14.3 mm Hg; P < .001) with poor consistency (r = 0.410; R2 = 0.168; ICC, 0.105) but only minor differences between FN-PVP and D-PVP (-0.5 mm Hg; P = .134) with good consistency (r = 0.951; R2 = 0.904; ICC, 0.944). This pattern did not change when pressure gradients were compared (R2 = 0.083/0.767) and adjusted by stiffness measurements and platelet counts (R2 = 0.196/0.789). The W-HVP/D-PVP and FN-PVP/D-PVP disagreement occurred in 47.8% (34 with IHVS, 91.9%) and 0.0% of patients, respectively. In multivariate linear regression, only the presence of portal vein thrombosis (P = .045) was an independent predictor for the lower FN-PVP/D-PVP ratio. Portosystemic pressure gradient of FN-PVP showed greater ability to stratify that of D-PVP of 16 mm Hg (area under the curve, 1.000 vs 0.574; P < .001) and 20 mm Hg (0.974 vs 0.662; P = .001) than that of W-HVP.
CONCLUSIONS: FN-PVP measurement may be a valid and safe approach to reflect the severity of sinusoidal portal hypertension in patients with IHVS.
MATERIALS AND METHODS: One hundred fifty-six consecutive patients planning to receive a transjugular intrahepatic portosystemic shunt in the authors' center were screened for study participation. The FN-PVP, D-PVP, and W-HVP were assessed for consistency by Pearson coefficient (r), linear regression coefficient (R2), and intraclass correlation coefficient (ICC) and for disagreement (error exceeding 20% of D-PVP) by the Bland-Altman method.
RESULTS: Of 92 eligible patients, FN-PVP was successfully obtained in 37 (40.2%) with IHVS, with no puncture-related adverse events. In these patients, there were significant differences between W-HVP and D-PVP (-14.3 mm Hg; P < .001) with poor consistency (r = 0.410; R2 = 0.168; ICC, 0.105) but only minor differences between FN-PVP and D-PVP (-0.5 mm Hg; P = .134) with good consistency (r = 0.951; R2 = 0.904; ICC, 0.944). This pattern did not change when pressure gradients were compared (R2 = 0.083/0.767) and adjusted by stiffness measurements and platelet counts (R2 = 0.196/0.789). The W-HVP/D-PVP and FN-PVP/D-PVP disagreement occurred in 47.8% (34 with IHVS, 91.9%) and 0.0% of patients, respectively. In multivariate linear regression, only the presence of portal vein thrombosis (P = .045) was an independent predictor for the lower FN-PVP/D-PVP ratio. Portosystemic pressure gradient of FN-PVP showed greater ability to stratify that of D-PVP of 16 mm Hg (area under the curve, 1.000 vs 0.574; P < .001) and 20 mm Hg (0.974 vs 0.662; P = .001) than that of W-HVP.
CONCLUSIONS: FN-PVP measurement may be a valid and safe approach to reflect the severity of sinusoidal portal hypertension in patients with IHVS.