A short tread 🧵 on HVPG:

1. Indications for HVPG
2. How to interpret HVPG
3. The role of HVPG in managing portal hypertension
4. How HVPG is performed

Hepatic venous pressure gradient (HVPG) is the gold-standard for measurement of portal hypertension. This paper in JHEP by Reverter et al's paper assessed prognostic role of HVPG in elective extrahepatic surgery and found ASA, HVPG and high-risk surgery as prognostic factors

Hepatic Vein Pressure Gradient 👊

“Anything Worth Doing Should Be Done Right”

▪️Required equipment
▪️Adequate calibration
▪️Adequate recording
▪️Actual measurement

Overview of quality HVPG outlined for non-IR! 👇

🔗 aasldpubs.onlinelibrary.wiley.com/doi/epdf/10.10…

#DDW2023 #LiverTwitter Elliot Tapper

Does HVPG accurately reflect portal pressure in NASH?
Great presentation Susana Rodrigues

HVPG measurement at #JUGA Preceptorship ⁦Arbeitsgemeinschaft Junge Gastroenterologie (JuGa)⁩ ⁦Maasoumy_liverlab⁩

📢New data on ammonia in stable ACLD #livertwitter
👉Diabetes - 📈ammonia.
👉Linked with key disease-driving mechanisms.
👉Predicts liver-related outcomes, independently of established prognostic indicators including CRP/HVPG.
❓Direct ammonia toxicity❓
doi.org/10.1016/j.jhep…

33T運用入りのトタ81は乗り入れ不可により急遽通快高尾行きに変更

Paradigm shifts in 🤔 about portal hypertension by ⁦Guadalupe GarciaTsao⁩

🔸Prevent decompensation (NSBB in patients with CPTH)
🔸 LSM and Plt 🚫 EGD for 👀varices
🔸NSBB can be used in ascites if MAP>65, SBP>90
🔸After TIPs: NSBB if HVPG is >12

#TLM23 ⁦AASLD⁩

💉🩸 FIB-4>=1,75 /VITRO >=2,5 detecta cACLD & estratifica riesgo de CSPH
✨ Comparable a LSM/HVPG
journals.lww.com/hep/abstract/9…

#LiverTwitter
Prognostic performance of non-invasive tests #NITs for portal hypertension #CSPH yield similar prognostic information as measurement of hepatic venous pressure gradient #HVPG
sciencedirect.com/science/articl…

Just out in JHEP Reports
In patients with cirrhosis undergoing liver transplantation, HVPG predicts:
➡️ major intraoperative bleeding
➡️ postoperative acute renal failure
➡️ vasopressor infusion duration
➡️ ICU length of stay

doi.org/10.1016/j.jhep…

Sweet blood & sour outcomes in cirrhosis

Pts. with compensated ACLD & diabetes:
🔻HVPG-response 😦
🔺Risk of hepatic decompensation, independent of HVPG-response ☹️

❓Mechanism
❗️More work to do #LiverTwitter

onlinelibrary.wiley.com/doi/10.1111/ap…

NIT for CSPH prediction - can they identify cACLD patients at risk for decompensation with similar accuracy as the HVPG?

Turns out: yes! 🙌

➡️ implications for clinical practice (prognostication and treatment)
💡time for a NIT-based PREDESCI study!

journal-of-hepatology.eu/article/S0168-…

🆕Validation of #Baveno VII criteria & NIT for CSPH in #hepatitis delta

✅NIT identify high-risk HDV-cACLD patients similar to HVPG w/high accuracy
💡NIT may guide novel antiviral treatment prioritization & individualized prognostication

🔗t.ly/c_Bzg #livertwitter

Hepatology journal club this month:

- carvedilol vs propanolol for secondary ppx after variceal bleeding🩸 🇦🇹

⬆️Better HVPG response
⬇️Less rebleeding
⬆️ Better liver-related survival

Thanks to @UMN GI Fellowship fellow Ioannis Pothoulakis for a great presentation

#hepjc

Infographic of how it's performed for trainees who are unaware of HVPG #fgdebate

'Portal hypertension in MASLD and how to measure it' presented at the #SLDSummit in Prague: Thomas Reiberger (AT)

Take Home Message: PH in MASLD

1. Steatosis & endothelial dysfunction in MASLD affect PH severity

2. HVPG seems to underestimate 'true' PP in MASLD, thus, MASLD

2024/3/30
9011レ　カシオペア紀行盛岡行
EF81 95 ＋ E26系12B
@尾久〜赤羽

本日のカシ釜は95号機でした
撮影地でご一緒した方お疲れ様でした

🚨 #LiverTwitter

‼️ #Diabetes impairs #HVPG response to #NSBB Betablockers in pts with #Cirrhosis

😱 even if patients with #Diabetes achieve HVPG response to #NSBB , their risk for #Decompensation is higher

📕 roypounder.apt
bit.ly/44OJzf4

EUS-pressures… A fascinating opportunity to assess presinusoidal PHTN

HVPG 👎 here

EUS ✅
👉25G FNA💉
👉PV, f/b HV/IVC

Voila! We have true Porto-Systemic gradient

🚫need for special pressure measuring 💉
Any 💉 works with std multipara monitors

#Endohepatology #GITwitter