Doppler sonography and hepatic vein catheterization in portal hypertension: assessment of agreement in evaluating severity and response to treatment

Abstract

Background/Aim: The study was designed to assess to what extent portal hemodynamic parameters obtained by duplex Doppler ultrasonography may be substituted for the measurement of hepatic venous pressure gradient in evaluating the severity of portal hypertension and the response to medical treatment with betablockers or beta-blockers plus nitrates in patients with cirrhosis and portal hypertension. Methods: In 39 of these patients hepatic venous pressure gradient was determined by hepatic vein catheterization, and portal blood flow velocity and the congestion index of the portal vein were measured by duplex Doppler ultrasonography. In 19 of these patients the changes in hepatic venous pressure gradient and in Doppler parameters were also assessed after chronic administration of nadolol. In 11 of the 19 patients the changes after chronic administration of nadolol plus isosorbide-5-mononitrate were also measured. Results: In the whole series, no significant correlation was found between hepatic venous pressure gradient and duplex Doppler parameters, but, when the 12 patients with a patent para-umbilical vein were excluded, significant linear correlations were found between hepatic venous pressure gradient and portal blood velocity ( r=−0.39; p=0.05) or congestion index ( r=0.37; p=0.05). Considering together the changes induces by nadolol and nadolol plus isosorbide-5-mononitrate, no correlation was apparent between changes in duplex Doppler parameters and in hepatic venous pressure gradient. Agreement between hepatic venous pressure gradient and duplex Doppler parameters in defining good and poor responders was insufficient. Conclusions: These data suggest that portal blood velocity and the congestion index of the portal vein are related to portal hypertension in patients without a patent para-umbilical vein, but are of limited value in discriminating good responders from poor responders to medical treatment for portal hypertension.