Comparison of balloon vs. straight catheter for the measurement of portal hypertension.
BACKGROUND
The hepatic venous pressure gradient (HVPG) is used as an estimation of portal pressure (PP) in the management of patients with cirrhosis. Two methods are available using either a straight or a balloon catheter, but have never been compared head-to-head.


OBJECTIVE
To compare the two methods of determining HVPG, straight and balloon catheter, regarding reproducibility and reliability.


METHODS
In 47 patients with liver cirrhosis, HVPG was assessed using both catheters in sequence. In another 29 patients, the wedged hepatic venous pressure (WHVP) determined either with straight or balloon catheter was correlated with a direct measurement of PP. Variation coefficient and intraclass correlation coefficient were calculated.


RESULTS
Variation coefficients for balloon catheter were 0.07 (HVPG), 0.02 (WHVP) and 0.06 [free hepatic venous pressure (FHVP)]. Variation coefficients for straight catheter were 0.17 (HVPG), 0.06 (WHVP) and 0.07 (FHVP), demonstrating a significantly wider variation of the HVPG and WHVP measurements (P < 0.001). Comparison of WHVP with PP revealed a correlation coefficient of 0.72 (P = 0.004) using balloon catheter and 0.58 (P = 0.011) using straight catheter.


CONCLUSIONS
Measurements with the balloon catheter currently represent the most reliable and reproducible method to assess HVPG. The results are of particular clinical relevance if repeated measurements are required for therapeutic adjustments.
Department of Internal Medicine I, Martin-Luther-University Halle-Wittenberg, Halle/Saale, SA, Germany. alexander.zipprich@medizin.uni-halle.de
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Zipprich
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Winkler
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Seufferlein
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Dollinger
D000328:Adult; D000368:Aged; D002404:Catheterization / Q000379:methods*; D006801:Humans; D006975:Hypertension, Portal / Q000503:physiopathology* / Q000628:therapy; D008103:Liver Cirrhosis / Q000150:complications*; D008875:Middle Aged; D017082:Portal Pressure / Q000502:physiology; D014690:Venous Pressure / Q000502:physiology