Correlation and Consistency Analysis between Various Indirect Portal Pressure Gradients and Actual Portal Pressure Gradient

Correlation and Consistency Analysis between Various Indirect Portal Pressure Gradients and Actual Portal Pressure Gradient | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Correlation and Consistency Analysis between Various Indirect Portal Pressure Gradients and Actual Portal Pressure Gradient Rufeng Chen, Yaozu Liu, Li Ma, Wen Zhang, Jiaze Yu, Minjie Yang, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5297383/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 10 Apr, 2025 Read the published version in BMC Gastroenterology → Version 1 posted 4 You are reading this latest preprint version Abstract Objective : To evaluate the correlation and consistency between hepatic venous pressure gradient(F-HVPG) calculated as the wedged hepatic venous pressure (WHVP) minus free hepatic venous pressure (FHVP), I-HVPG calculated as WHVP minus inferior vena cava pressure (IVCP) in the hepatic segment, and portal pressure gradient (PPG). Methods : Data were collected from 112 patients with portal hypertension undergoing transjugular intrahepatic portosystemic shunt (TIPS) along with HVPG measurement. FHVP, IVCP, WHVP, and portal venous pressure (PVP) were collected intraoperatively. Pearson’s correlation and Bland–Altman method were used to assess correlation and consistency. Results :A total of 112 patients were retrospectively collected. The correlation coefficient (r) velues ( p < 0.001) between FHVP and IVCP, F-HVPG and I-HVPG, F-HVPG and PPG, I-HVPG and PPG were 0.835, 0.946, 0.667 and 0.698, respectively; the determination coefficient (R 2 ) values were 0.697, 0.895, 0.445 and 0.487, respectively. Bland–Altman plots showed that F-HVPG and I-HVPG had the narrowest 95% limits of agreement. Among patients with FHVP-IVCP > 2 mmHg, the (r) vlues ( p < 0.05) between F-HVPG and I-HVPG, F-HVPG and PPG,I-HVPG and PPG were 0.907, 0.648 and 0.807, respectively; the (R 2 ) values were 0.822, 0.420 and 0.651, respectively. Bland–Altman plots showed that I-HVPG had the narrower 95% limits of agreement with PPG. Conclusion : F-HVPG and I-HVPG demonstrated high correlation and consistency. When the difference between FHVP and IVCP is greater than 2 mmHg, IVCP should be used to calculate HVPG instead of FHVP. portal hypertension inferior vena cava pressure portal pressure gradient hepatic venous pressure gradient transjugular intrahepatic portosystemic shunt (TIPS) Figures Figure 1 Figure 2 Figure 3 Figure 4 INTRODUCTION Portal hypertension (PHT) is one of the primary complications of liver cirrhosis, and its severity determines the occurrence and progression of decompensated events in advanced cirrhosis [ 1 ] . The portal pressure gradient (PPG) is defined as the difference between the portal vein pressure (PVP) and the inferior vena cava pressure (IVCP) [ 2 ][ 3 ] .PPG provides the most accurate assessment of the severity and prognosis of portal hypertension, but its measurement requires direct portal vein catheterization, which limits its clinical application. The hepatic venous pressure gradient (HVPG) [ 4 ] , the difference between the wedged hepatic venous pressure (WHVP) [ 5 ] and the free hepatic venous pressure (FHVP), remains the gold standard for assessing portal hypertension. Recommendations [ 2 ] suggest that HVPG values > 5 mmHg indicate sinusoidal portal hypertension; HVPG ≧ 10 mmHg defined clinically significant portal hypertension(CSPH).An increasing body of research confirms its utility across various fields of hepatology [ 6 ] [ 7 ] [ 8 ] . FHVP [ 7 ] should be measured approximately 2–3 cm proximal to the junction of the hepatic vein (HV) and the inferior vena cava (IVC). If the pressure difference between FHVP and IVCP is > 2 mmHg, the possibility of hepatic vein obstruction should be considered [ 2 ] . Some studies suggest that when the absolute difference between FHVP and IVCP exceeds 2 mmHg, WHVP-IVCP can be used to calculate HVPG [ 2 ][ 10 ] . Additionally, in routine practice, the compliance balloons commonly used lack length markers, making it challenging to accurately position the balloon catheter at the optimal measurement location. Rössle et al. [ 10 ] revealed that FVHP measurement highly depends on catheter tip position and vein morphology. Therefore, we designed this study with the aim of assessing (1) weather IVCP can replace FHVP in calculating HVPG and (2) When FHVP-ICVP is greater than 2 mmHg, should IVCP or FHVP be used to calculate HVPG? MATERIALS AND METHODS Patients This retrospective study was approved by the institutional review board, and written informed consent to participate in the study was obtained from each patient. The study included 150 consecutive HVPG measurements obtained during TIPS creation from 2020 to 2022. Exclusion criteria were: non-sinusoidal portal hypertension; imaging confirmation of complete occlusive portal vein thrombosis (PVT); severe acities. According to the inclusion and exclusion criteria, 112 patients were eligible for this study (Fig. 1 ).We divided patients into Group A if the difference between IVCP and FHVP was greater than 2 mmHg, and into Group B if the difference was less than 2 mmHg. Measurement of HVPG and PPG Before the procedure, contrast-enhanced 64-slice spiral computed tomography (CT) venography and vascular ultrasound were conducted to assess the patency of the IVC, HV, intrahepatic portal vein, and jugular vein. Additionally, CT venography was used to diagnose portosystemic shunt and ascites. After accessing the jugular vein, the pressure of the right atrium and IVC was measured using a 4F pigtail catheter (Cook Medical, Bloomington, Indiana). Subsequently, a 4F Cobra catheter (Cook Medical) was utilized to catheterize the hepatic vein. This catheter was then replaced with a compliant 5.5F Fogarty balloon catheter (Edwards Lifesciences, Irvine, California), which was connected to a pressure transducer. The tip of the balloon catheter was positioned approximately 1–3 cm from the IVC in the right or middle hepatic vein [ 4 ] [ 9 ] [ 11 ] . Zero adjustment of the transducer was conducted at the level of the right atrium. FHVP was measured while the balloon was deflated and allowed to float freely in the HV. Subsequently, the balloon was inflated with dilute contrast medium until complete occlusion of the target vein, and WHVP was obtained. Venography of the occluded hepatic vein was performed by using a power injector to inject 5 mL of iopromide contrast medium (Ultravist 300; Bayer AG, Leverkusen, Germany) at a rate of 2 mL/s to confirm total occlusion of the balloon at the end of the WHVP measurement. FHVP and WHVP measurements were repeated at least three times using one or two different hepatic veins, and the results were averaged. The 4F pigtail catheter (Cook Medical) was introduced into the main portal vein immediately after successful puncture using the RUPS-100 system (Cook Medical). Direct portal venous pressure was then measured prior to stent placement. The measurement duration was 1 minute, during which stable values were recorded for each part. F-HVPG was calculated by subtracting FHVP from WHVP. I-HVPG was calculated by subtracting IVCP from WHVP. The PPG was defined as the difference between PVP and IVCP. Statistical Analysis Statistical analysis was conducted using IBM SPSS Version 20.0 software (IBM Corp, Armonk, New York). Continuous variables conforming to the normal distribution were expressed as mean ± standard deviation, and comparisons between groups were conducted using independent sample or paired sample t-tests. Continuous variables not conforming to the normal distribution were represented by the median (25th to 75th percentiles). Paired t-tests were used for self-comparisons before and after the intervention, and comparisons between groups were performed using the Mann-Whitney U test or the Kruskal-Wallis test. The correlations between pairs of variables were analyzed using Pearson’s correlation tests to estimate Pearson’s correlation coefficients (r) and the determination coefficients (R 2 ). Consistency was assessed using Bland–Altman method. The smaller the range of 95% limits of agreement (LoA) is, the better the agreement. The level of statistical significance was set at P < 0.05. RESULTS Patient characteristics According to the inclusion and exclusion criteria, 112 patients were eventually enrolled in this study. Hepatitis B virus infection was the predominant etiology of cirrhosis (89.3%). The majority of patients undergoing TIPS were indicated for gastrointestinal hemorrhage (80.4%), while a small portion is for ascites (19.6%).There was no significant difference in baseline characteristics between two groups except for liver stiffness value ( p < 0.001). The baseline characteristics of the patients are summarized in Table 1 .During HVPG Measurement and TIPS Creation, only the FHVP of group A was significantly higher than that of group B.Mean Pressures of Each Part during HVPG Measurement and TIPS Creation are shown in Table 2 Table 1 Baseline Characteristics of Patients Variables Total N = 112 Group A N = 18 Group B N = 94 P value Age (years) 54 ± 13 52 ± 10 50 ± 11 0.882 Sex Male Female 81 (72.3%) 31 (27.7%) 14 (77.8%) 4 (22.2%) 67 (71.3%) 27 (28.7%) 0.350 Child-Turcotte-Pugh score 6.1 ± 0.8 6.1 ± 1.1 6.1 ± 0.9 0.281 Indications Gastrointestinal hemorrhage Ascites 90 (80.4%) 22 (19.6%) 13 (72.2%) 5 (27.8%) 74 (78.7%) 17 (18.1%) 0.427 Etiology HBV HCV ALC 100 (89.3%) 7 (6.25%) 5 (4.46%) 17 (94.4%) 1 (5.6%) 0 83 (88.3%) 6 (6.4%) 5 (5.3%) 0.222 Total bilirubin,µmol/L 19.8 ± 8.9 22.2 ± 10.2 18.5 ± 8.9 0.207 ALT, U/L 19.3 ± 17.9 22.0 ± 17.1 19.5 ± 16.9 0.078 AST, U/L 30.6 ± 18.3 31.3 ± 18.8 30.3 ± 17.6 0.094 Albumin, g/L 37.4 ± 5.4 35.8 ± 4.2 38.5 ± 6.5 0.440 SCr, µmol/L 77.8 ± 24.8 75.4 ± 28.1 77.4 ± 25.5 0.798 PT, s 14.8 ± 2.3 14.8 ± 2.2 14.9 ± 3.1 0.834 Platelet count,10 9 /L 66.1 ± 37.2 67.2 ± 35.2 65.8 ± 37.1 0.891 International normalized ratio 1.3 ± 0.1 1.3 ± 0.2 1.3 ± 0.2 0.056 MELD score 10.4 ± 3.1 10.5 ± 3.3 9.9 ± 3.9 0.087 Liver stiffness value ,kPa 15.8 ± 5.3 16.8 ± 4.2 15.2 ± 3.9 0.001 Note–Values are reported as mean ± SD or n (%). Abbreviations: HBV = hepatitis B virus–related cirrhosis; HCV = hepatitis C virus–related cirrhosis; ALC = alcoholic liver cirrhosis;ALT = alanine transaminase; AST = aspartate transaminase; PT = prothrombin time; SCr = serum creatinine; MELD = model for end-stage liver disease. Table 2 Mean Pressures of Each Part during HVPG Measurement and TIPS Creation All N = 112 Group A N = 18 Group B N = 94 P value IVCP, mmHg 5.21 ± 2.84 6.02 ± 3.36 5.44 ± 2.79 0.294 FHVP, mmHg 6.31 ± 3.78 9.86 ± 4.78 5.27 ± 2.74 <0.0001 WHVP,mmHg 22.82 ± 6.98 25.00 ± 7.51 22.40 ± 6.84 0.227 PVP, mmHg 26.64 ± 6.11 28.56 ± 7.06 26.66 ± 6.15 0.042 F-HVPG,mmHg 16.51 ± 6.64 15.94 ± 6.62 16.97 ± 6.60 0.266 I-HVPG,mmHg 17.62 ± 6.69 20.11 ± 7.19 17.14 ± 6.53 0.041 PPG, mmHg 21.44 ± 6.08 23.67 ± 6.31 21.39 ± 6.07 0.580 Abbreviations: FHVP: free hepatic venous pressure; HVPG: hepatic venous pressure gradient; IVCP: inferior vena cava pressure; PPG: portal venous pressure gradient; PVP: portal venous pressure; TIPS: transjugular intrahepatic portosystemic shunt; WHVP: wedged hepatic venous pressure. Relationship between IVCP and FHVP, I-HVPG and F-HVPG, I-HVPG and PPG, F-HVPG and PPG in all patients Among all patients (Fig. 2 a), the mean IVCP was similar to FHVP (5.21 ± 2.84 mmHg vs 6.31 ± 3.78 mmHg, P = 0.43),with a correlation coefficient of 0.835 and a coefficient of determination of 0.697 ( p < 0.001). The range of 95% LoA between IVCP and FHVP was from (-2.84) to 3.98 mmHg (Table 3 ). The mean I-HVPG was higher than F-HVPG (17.62 ± 6.69 mmHg vs 16.51 ± 6.64 mmHg, P < 0.01), with a correlation coefficient of 0.946 and a coefficient of determination of 0.895 ( p < 0.001). The range of 95% LoA between I-HVPG and F-HVPG was from (-4.86) ~ 3.59 mmHg (Table 3 ). Table 3 Relationship between IVCP and FHVP, HVPG-free and I-HVPG, HVPG-free and PPG, I-HVPG and PPG from all patients r R 2 P- value 95% LoA (mmHg) IVCP/FHVP 0.835 0.697 < 0.001 (-2.84) ~ 3.98 F-HVPG/I-HVPG 0.946 0.895 < 0.001 (-4.86) ~ 3.59 F-HVPG/PPG 0.667 0.445 < 0.0001 (-15.14) ~ 5.28 I-HVPG/PPG 0.698 0.487 < 0.0001 (-13.61) ~ 5.97 Abbreviations: FHVP: free hepatic venous pressure; HVPG: hepatic venous pressure gradient; IVCP: inferior vena cava pressure; PPG: portal venous pressure gradient; PVP: portal venous pressure; TIPS: transjugular intrahepatic portosystemic shunt; WHVP: wedged hepatic venous pressure. LoA, limits of agreement; r: Pearson’s correlation; R 2 : the coefficient of determination Among all patients (Fig. 2 b), the mean PPG(21.44 ± 6.08 mmHg) was both higher than I-HVPG and F-HVPG and the differences were statistically significant( p < 0.05)(Table 2 ). The r and R 2 values of F-HVPG and PPG were 0.667 and 0.445, respectively ( p < 0.0001). The range of 95% LoA between F-HVPG and PPG was from (-15.14) ~ 5.28 mmHg (Table 3 ). The r and R 2 values of I-HVPG and PPG were 0.698 and 0.487, respectively ( p < 0.0001). The range of 95% LoA between I-HVPG and PPG was from (-13.61) ~ 5.97 mmHg (Table 3 ). Relationship between IVCP and FHVP, I-HVPG and F-HVPG, I-HVPG and PPG, F-HVPG and PPG in Group A In the Group A, The mean IVCP was lower than FHVP (6.02 ± 3.36 mmHg vs 11.06 ± 4.78 mmHg, P < 0.001), with a correlation coefficient of 0.777 and a coefficient of determination of 0.603 ( p = 0.002). The range of 95% LoA between IVCP and FHVP was from 0.22 to 12.11 mmHg (Table 4 ). The mean I-HVPG was higher than F-HVPG(20.11 ± 7.19 mmHg vs 13.94 ± 6.62 mmHg, P < 0.001),with a correlation coefficient of 0.907 and a coefficient of determination of 0.822 ( p < 0.001). The range of 95% LoA between F-HVPG and I-HVPG was from (-12.11) to 0.21 mmHg (Table 4 ). Table 4 Relationship between IVCP and FHVP, HVPG-free and I-HVPG, HVPG-free and PPG, I-HVPG and PPG from group A and group B Group A Group B r R 2 P 95%LoA (mmHg) r R 2 P 95%LoA (mmHg) IVCP/FHVP 0.777 0.603 0.0002 0.22 ~ 12.11 0.991 0.982 < 0.0001 (-0.57) ~ 0.91 F-HVPG/I-HVPG 0.907 0.822 < 0.001 (-12.11) ~ 0.21 0.998 0.997 < 0.0001 (-0.91) ~ 0.57 F-HVPG/PPG 0.648 0.420 0.004 (-18.37) ~ 2.92 0.683 0.466 < 0.0001 (-14.36) ~ 5.51 I-HVPG/PPG 0.807 0.651 < 0.0001 (-9.93) ~ 6.82 0.684 0.468 < 0.0001 (-14.10) ~ 5.59 Abbreviations: FHVP: free hepatic venous pressure; HVPG: hepatic venous pressure gradient; IVCP: inferior vena cava pressure; PPG: portal venous pressure gradient; PVP: portal venous pressure; TIPS: transjugular intrahepatic portosystemic shunt; WHVP: wedged hepatic venous pressure. LoA, limits of agreement; r: Pearson’s correlation; R 2 : the coefficient of determination In the Group A (Fig. 3 ), the mean PPG (21.67 ± 6.31 mmHg) was both higher than I-HVPG and F-HVPG and the differences were statistically significant( p < 0.01)(Table 2 ). The r and R 2 values of F-HVPG and PPG were 0.648 and 0.420, respectively(( p = 0.004). The range of 95% LoA between F-HVPG and PPG was from (-18.37) ~ 2.92 mmHg (Table 4 ). The r and R 2 values of I-HVPG and PPG were 0.807 and 0.651, respectively ( p < 0.0001). The range of 95% LoA between I-HVPG and PPG was from (-9.93) ~ 6.82 mmHg (Table 4 ). Relationship between IVCP and FHVP, I-HVPG and F-HVPG, I-HVPG and PPG, F-HVPG and PPG in Group B I n the Group B (Fig. 4 a), The mean IVCP was similar to FHVP (5.44 ± 2.79 mmHg vs 5.27 ± 2.74 mmHg, p = 0.673), with a correlation coefficient of 0.991 and a coefficient of determination of 0.982 < 0.0001). The range of 95% LoA between IVCP and FHVP was from (-0.57) ~ 0.91 mmHg (Table 4 ). The mean I-HVPG was also similar to F-HVPG(16.97 ± 6.60 mmHg vs 17.14 ± 6.53 mmHg, p = 0.859),with a correlation coefficient of 0.998 and a coefficient of determination of 0.997 ( p < 0.0001). The range of 95% LoA between F-HVPG and I-HVPG was from (-0.91) ~ 0.57 mmHg (Table 4 ). In the Group B (Fig. 4 b), the mean PPG (21.39 ± 6.07 mmHg) was both higher than I-HVPG and F-HVPG ( p < 0.05) (Table 2 ). The r and R 2 values of F-HVPG and PPG were 0.683 and 0.466, respectively ( p < 0.0001). The range of 95% LoA between F-HVPG and PPG was from (-14.36) ~ 5.51 mmHg (Table 4 ). The r and R 2 values of I-HVPG and PPG were 0.684 and 0.468, respectively ( p < 0.0001). The range of 95% LoA between I-HVPG and PPG was from (-14.10) ~ 5.59 mmHg (Table 4 ). Stratification of portal hypertension Among all patients, the area under curves of F-HVPG and I-HVPG were 0.687 and 0.693 (p < 0.001) forstratifying PHT of 16 mmHg and 0.623 and 0.644(p = 0.001) for stratifying PHT of 20 mmHg. In the Group A, the area under curves of F-HVPG and I-HVPG were 0.582 and 0.867 (p < 0.001) forstratifying PHT of 16 mmHg and 0.540 and 0.831 (p = 0.001) for stratifying PHT of 20 mmHg. DISCUSSION In this study aiming to explore whether IVCP can be used instead of FHVP to calculate HVPG, we found that when FHVP-IVCP > 2 mmHg, I-HVPG could better define PPG. Our data also suggested that high correlation and consistency were found between I-HVPG and F-HVPG. The most common cause of cirrhosis in China is viral hepatitis B infection [ 12 ] . Patients with sinusoidal cirrhosis, with an HVPG ≥ 10 mmHg(CSPH), are considered to have a significantly increased probability of decompensated events such as ascites, bleeding, and hepatic encephalopathy [ 13 ] [ 14 ] [ 15 ] .Thus, the measurement of HVPG is of great importance. The accuracy of HVPG highly depends on the accuracy of the technique [ 4 ] .However, in clinical practice, the compliant balloon used lacks length markings, making it difficult to precisely position the balloon catheter at the optimal measurement location. Rössle et al. [ 16 ] pointed out that due to the conical shape of the hepatic vein, the measurement of free hepatic venous pressure strongly relies on the position of the measuring catheter tip. They suggested that an 8-French catheter (diameter 2.4 mm), regardless of the position of the catheter tip, would cause 20% or more obstruction in small hepatic veins with a diameter of 6 mm, leading to a falsely elevated FHVP by 20%. In decompensated cirrhotic patients undergoing HVPG measurements, hepatic veins are typically atrophic and narrowed to varying degrees, which exacerbates this error. As a result, HVPG will be far lower than the true value, failing to reflect the actual PPG. Hiang Keat Tan et al. [ 17 ] conducted a similar study, suggesting that when FHVP is recorded at a position further away from the junction of the hepatic vein (HV) and IVC, it is likely due to relative obstruction of the catheter or gradual wedging into narrower hepatic veins, leading to falsely elevated FHVP measurements. This false elevation of FHVP significantly affects the accuracy and effectiveness of HVPG. Since IVCP is not influenced by changes in catheter position, the difference between FHVP and IVCP will increase when measured from the proximal to distal positions of the hepatic vein. In our study, among the 18 patients with FHVP-IVCP differences greater than 2 mmHg, I-HVPG showed better correlation and consistency with PPG.While the correlation and consistency between F-HVPG and PPG were statistically significant, with the increase in FHVP, there was a corresponding decrease in HVPG, which could not reflect the true PPG.Moreover, in patients with FHVP-IVCP differences greater than 2 mmHg, I-HVPG possessed a better ability to stratify PHT of 16 mmHg and 20 mmHg than that of F-HVPG (0.582 vs 0.867, 0.540 vs 0.831). It means that using I-HVPG can reduce the misdiagnosis rate of severe PHT significantly. Silva-Junior et al. [ 18 ] suggested that I-HVPG showed poor significance in predicting survival without liver transplantation, thus strongly advising against using IVCP to calculate HVPG under any circumstances. Among the patients included in his study, 85.3% were infected with HCV and suffered from alcoholic cirrhosis, and the causes of the remaining 14.7% were not specified; in addition, no description was given about whether the patients were in the compensated or decompensated stage of liver cirrhosis. In our study, all patients were in the decompensated stage with sinusoidal cirrhosis. Therefore, using IVCP to calculate HVPG in clinical practice is advisable. The measurement of venous pressure is influenced by many factors [ 19 ] [ 20 ] [ 21 ] , such as the use of some drugs (e.g., Propranolol), the presence of large amounts of ascites, and deep anesthesia. To avoid such influences, all of our measurements were performed under local anesthesia using the standardized method described previously and the patients with severe ascities were excluded. This study has several limitations: First, we did not know the cause of the elevated FHVP, which requires further study with more case samples;Second, only decompensated cirrhotic patients with sinusoidal PHT were enrolled. Further study will explore the value of I-HVPG in patients with non-sinusoidal PHT. Third, this was a retrospective study, using records from a single medical center. Further research is needed to validate the results using larger sample sizes and prospective studies. In summary, F-HVPG and I-HVPG exhibited high correlation and consistency, making the use of IVCP to calculate HVPG preferable in clinical practice. When the difference between FHVP and IVCP exceeds 2 mmHg, HVPG might greatly underestimate the actual PVP value. IVCP should be used to calculate HVPG rather than FHVP. Abbreviations DSA: digital subtraction angiography FHVP: free hepatic venous pressure WHVP: wedged hepatic venous pressure HVPG: hepatic venous pressure gradient IVCP: inferior vena cava pressure PPG: portal venous pressure gradient PVP: portal venous pressure TIPS: transjugular intrahepatic portosystemic shunt NSBBs: nonselective β-blockers Declarations Funding This study was supported by grants from Device development exploration project from National Clinical Research Center for Interventional Medicine (2021-001), Shanghai key clinical specialty construction program (W2019028), Excellent youth program from Zhongshan Hospital, Fudan University (2019ZSYXQN38) and Clinical research special fund from Zhongshan Hospital, Fudan University (2018ZSLC23). Author Contribution JL and JM contributed to the study’s conception and design. Material preparation and data collection were performed by RC, JM, WZ, MY, YL, JY, JL, YZ and ZY. Data analysis and interpretation were performed by LM, JM, WZ and JL. The first draft of the manuscript was written by RC and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Data availability Data available on request from the authors. References Ginès P, Krag A, Abraldes JG, Solà E, Fabrellas N, Kamath PS. Liver cirrhosis. Lancet. 2021;398(10308):1359–76. De Franchis R, Bosch J, Garcia-Tsao G, Reiberger T, Ripoll C, Abraldes JG, et al. Baveno VII – Renewing consensus in portal hypertension. J Hepatol. 2022;76(4):959–74. Dittrich S, De Mattos AA, Becker M, Gonçaves DM, Cheinquer H. Role of Hepatic Hemodynamic Study in the Evaluation of Patients with Cirrhosis. Hepatogastroenterology. 2003;50(54):2052–6. Groszmann R, Vorobioff JD, Gao H. Measurement of Portal Pressure: When, How, and Why to Do It. Clin Liver Dis. 2006;10(3):499–512. Groszmann RJ, Glickman M, Blei AT, Storer E, Conn HO. Wedged and free hepatic venous pressure measured with a balloon catheter. Gastroenterology. 1979;76(2):253–8. Boike JR, Thornburg BG, Asrani SK, Fallon MB, Fortune BE, Izzy MJ, et al. North American Practice-Based Recommendations for Transjugular Intrahepatic Portosystemic Shunts in Portal Hypertension. Clin Gastroenterol Hepatol. 2022;20(8):1636–e166236. Ripoll C, Groszmann R, Garcia G, Grace N, Burroughs A, Planas R et al. Hepatic Venous Pressure Gradient Predicts Clinical Decompensation in Patients With. Compensated Cirrhosis. 2007;133(2). Kim TY, Lee JG, Sohn JH, Kim JY, Kim SM, Kim J, et al. Hepatic Venous Pressure Gradient Predicts Long-Term Mortality in Patients with Decompensated Cirrhosis. Yonsei Med J. 2016;57(1):138–45. Groszmann RJ, Wongcharatrawee S. The hepatic venous pressure gradient: anything worth doing should be done right. Hepatology. 2004;39(2):280–2. La Mura V, Abraldes JG, Berzigotti A, Erice E, Flores-Arroyo A, Carlos García-Pagán J, et al. Right atrial pressure is not adequate to calculate portal pressure gradient in cirrhosis: A clinical-hemodynamic correlation study. Hepatology. 2010;51(6):2108–16. Kumar A, Sharma P, Sarin SK. Hepatic venous pressure gradient measurement: Time to learn! Indian J Gastroenterol. 2008;27(2):74–80. Busch K, Thimme R. Natural history of chronic hepatitis B virus infection. Med Microbiol Immunol. 2015;204(1):5–10. D’Amico G, Morabito A, D’Amico M, Pasta L, Malizia G, Rebora P, et al. New concepts on the clinical course and stratification of compensated and decompensated cirrhosis. Hepatol Int. 2018;12(S1):34–43. La Mura V, Garcia-Guix M, Berzigotti A, Abraldes JG, García‐Pagán JC, Villanueva C, et al. A Prognostic Strategy Based on Stage of Cirrhosis and HVPG to Improve Risk Stratification After Variceal Bleeding. Hepatology. 2020;72(4):1353–65. Magaz M, Baiges A, Hernández-Gea V. Precision medicine in variceal bleeding: Are we there yet? J Hepatol. 2020;72(4):774–84. Rössle M, Blanke P, Fritz B, Schultheiss M, Bettinger D. Free Hepatic Vein Pressure Is Not Useful to Calculate the Portal Pressure Gradient in Cirrhosis: A Morphologic and Hemodynamic Study. J Vasc Interv Radiol. 2016;27(8):1130–7. Tan HK, Tan AB, Teh KKJ, Gogna A, Too CW, Leong S, et al. Impact of catheter tip to hepatic vein ostium distance on the validity and prognostication of hepatic venous pressure gradient in cirrhosis. Sci Rep. 2023;13(1):16980. Silva-Junior G, Baiges A, Turon F, Torres F, Hernández‐Gea V, Bosch J, et al. The prognostic value of hepatic venous pressure gradient in patients with cirrhosis is highly dependent on the accuracy of the technique. Hepatology. 2015;62(5):1584–92. Alvarado-Tapias E, Ardevol A, Garcia-Guix M, Montañés R, Pavel O, Cuyas B, et al. Short-term hemodynamic effects of β-blockers influence survival of patients with decompensated cirrhosis. J Hepatol. 2020;73(4):829–41. Mandell MS, Durham J, Kumpe D, Trotter JF, Everson GT, Niemann CU. The Effects of Desflurane and Propofol on Portosystemic Pressure in Patients with Portal Hypertension. Anesth Analgesia. 2003;97(6):1573. Steinlauf AF, Garcia-Tsao G, Zakko MF, Dickey K, Gupta T, Groszmann RJ. Low-dose midazolam sedation: An option for patients undergoing serial hepatic venous pressure measurements. Hepatology. 1999;29(4):1070–3. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 10 Apr, 2025 Read the published version in BMC Gastroenterology → Version 1 posted Editorial decision: Revision requested 06 Nov, 2024 Editor assigned by journal 22 Oct, 2024 Submission checks completed at journal 22 Oct, 2024 First submitted to journal 20 Oct, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5297383","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":369290775,"identity":"dfaa0b33-4b28-4c8c-a932-51e8b8855d5e","order_by":0,"name":"Rufeng Chen","email":"","orcid":"","institution":"Shanghai Institution of Medical Imaging, Fudan University, Shanghai, China","correspondingAuthor":false,"prefix":"","firstName":"Rufeng","middleName":"","lastName":"Chen","suffix":""},{"id":369290776,"identity":"29d5a0ad-427d-4aad-a7bf-2ceeefdb880c","order_by":1,"name":"Yaozu Liu","email":"","orcid":"","institution":"Shanghai Institution of Medical Imaging, Fudan University, Shanghai, China","correspondingAuthor":false,"prefix":"","firstName":"Yaozu","middleName":"","lastName":"Liu","suffix":""},{"id":369290779,"identity":"a563e761-77cc-42d7-a7ff-11823a8777bc","order_by":2,"name":"Li Ma","email":"","orcid":"","institution":"Shanghai Institution of Medical Imaging, Fudan University, Shanghai, China","correspondingAuthor":false,"prefix":"","firstName":"Li","middleName":"","lastName":"Ma","suffix":""},{"id":369290783,"identity":"f6c7813e-67f0-4045-95bf-31a493d8708f","order_by":3,"name":"Wen Zhang","email":"","orcid":"","institution":"Department of Interventional Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai 200032, China","correspondingAuthor":false,"prefix":"","firstName":"Wen","middleName":"","lastName":"Zhang","suffix":""},{"id":369290784,"identity":"eb73c21b-8fc1-4afc-9504-a960b9456fca","order_by":4,"name":"Jiaze Yu","email":"","orcid":"","institution":"Department of Interventional Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai 200032, China","correspondingAuthor":false,"prefix":"","firstName":"Jiaze","middleName":"","lastName":"Yu","suffix":""},{"id":369290785,"identity":"12305138-4565-4a72-bbfd-e135d99d2882","order_by":5,"name":"Minjie Yang","email":"","orcid":"","institution":"Department of Interventional Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai 200032, China","correspondingAuthor":false,"prefix":"","firstName":"Minjie","middleName":"","lastName":"Yang","suffix":""},{"id":369290786,"identity":"b69ff4a2-c565-425c-b2f1-034c881927e6","order_by":6,"name":"Jianjun Luo","email":"data:image/png;base64,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","orcid":"","institution":"Department of Interventional Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai 200032, China","correspondingAuthor":true,"prefix":"","firstName":"Jianjun","middleName":"","lastName":"Luo","suffix":""},{"id":369290787,"identity":"998c94a7-9d40-4dc5-a7e6-8b7d2763d44e","order_by":7,"name":"Jingqin Ma","email":"","orcid":"","institution":"Department of Interventional Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai 200032, China","correspondingAuthor":false,"prefix":"","firstName":"Jingqin","middleName":"","lastName":"Ma","suffix":""},{"id":369290788,"identity":"ef9030f0-9cf3-4d5d-b3bf-1522c4b1552e","order_by":8,"name":"Yongjie Zhou","email":"","orcid":"","institution":"Department of Interventional Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai 200032, China","correspondingAuthor":false,"prefix":"","firstName":"Yongjie","middleName":"","lastName":"Zhou","suffix":""},{"id":369290789,"identity":"01e37fd9-3222-41c5-ade6-3975bbf802fc","order_by":9,"name":"Zhiping Yan","email":"","orcid":"","institution":"Department of Interventional Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai 200032, China","correspondingAuthor":false,"prefix":"","firstName":"Zhiping","middleName":"","lastName":"Yan","suffix":""}],"badges":[],"createdAt":"2024-10-20 08:23:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5297383/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5297383/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12876-025-03816-z","type":"published","date":"2025-04-10T16:05:23+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":68689158,"identity":"064c795f-d93e-4271-84ef-28ca6df46799","added_by":"auto","created_at":"2024-11-11 05:31:08","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":31853,"visible":true,"origin":"","legend":"\u003cp\u003eFlow diagram summarizing the patient enrollment process.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5297383/v1/79c6f37e136955d6f3d71843.png"},{"id":68689159,"identity":"a7137910-c3a3-4126-8039-f4013c0694a0","added_by":"auto","created_at":"2024-11-11 05:31:08","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":178177,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ea. \u003c/strong\u003e: All patients (n=112): A: Correlation between FHVP and IVCP; B: Correlation between F-HVPG and I-HVPG; C: Agreement between FHVP and IVCP according to Bland-Altman; D: Agreement between F-HVPG and I-HVPG according to Bland-Altman.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eb. \u003c/strong\u003e: All patients (n=112): A: Correlation between I-HVPG and PPG; B: Correlation between F-HVPG and PPG; C: Agreement between I-HVPG and PPG according to Bland-Altman; D: Agreement between F-HVPG and PPG according to Bland-Altman.\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5297383/v1/f9e3711de8aec020240fffd0.jpg"},{"id":68690022,"identity":"767cc894-68a4-4756-86b5-c3105092b6f5","added_by":"auto","created_at":"2024-11-11 05:39:08","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":97474,"visible":true,"origin":"","legend":"\u003cp\u003eGroup A (n=18): A: Correlation between F-HVPG and PPG; B: Correlation between I-HVPG and PPG; C: Agreement between F-HVPG and PPG according to Bland-Altman; D: Agreement between I-HVPG and PPG according to Bland-Altman.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-5297383/v1/67ad6b57a64f0337efa836e9.png"},{"id":68689160,"identity":"11ae0329-bae9-4b23-80a2-db6e0591e5dc","added_by":"auto","created_at":"2024-11-11 05:31:10","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":171162,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ea. \u003c/strong\u003e: Group B (n=94):A: Correlation between FHVP and IVCP; B: Correlation between F-HVPG and I-HVPG; C: Agreement between FHVP and IVCP according to Bland-Altman; D: Agreement between F-HVPG and I-HVPG according to Bland-Altman.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eb. \u003c/strong\u003e: Group B (n=94):A: Correlation between F-HVPG and PPG; B: Correlation between I-HVPG and PPG; C: Agreement between F-HVPG and PPG according to Bland-Altman; D: Agreement between I-HVPG and PPG according to Bland-Altman.\u003c/p\u003e","description":"","filename":"4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5297383/v1/dd8a76b9de75dbcad8f4901c.jpg"},{"id":80559063,"identity":"51ad0a3c-54bf-4036-9dcb-4ac900c0940c","added_by":"auto","created_at":"2025-04-14 16:17:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1207516,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5297383/v1/55ff34c3-21eb-4331-b35e-d6e80d7b54b7.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Correlation and Consistency Analysis between Various Indirect Portal Pressure Gradients and Actual Portal Pressure Gradient","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003ePortal hypertension (PHT) is one of the primary complications of liver cirrhosis, and its severity determines the occurrence and progression of decompensated events in advanced cirrhosis\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. The portal pressure gradient (PPG) is defined as the difference between the portal vein pressure (PVP) and the inferior vena cava pressure (IVCP)\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e][\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e.PPG provides the most accurate assessment of the severity and prognosis of portal hypertension, but its measurement requires direct portal vein catheterization, which limits its clinical application. The hepatic venous pressure gradient (HVPG)\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e, the difference between the wedged hepatic venous pressure (WHVP)\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e and the free hepatic venous pressure (FHVP), remains the gold standard for assessing portal hypertension. Recommendations\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e suggest that HVPG values\u0026thinsp;\u0026gt;\u0026thinsp;5 mmHg indicate sinusoidal portal hypertension; HVPG\u0026thinsp;≧\u0026thinsp;10 mmHg defined clinically significant portal hypertension(CSPH).An increasing body of research confirms its utility across various fields of hepatology\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eFHVP\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e should be measured approximately 2\u0026ndash;3 cm proximal to the junction of the hepatic vein (HV) and the inferior vena cava (IVC). If the pressure difference between FHVP and IVCP is \u0026gt;\u0026thinsp;2 mmHg, the possibility of hepatic vein obstruction should be considered\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Some studies suggest that when the absolute difference between FHVP and IVCP exceeds 2 mmHg, WHVP-IVCP can be used to calculate HVPG\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e][\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. Additionally, in routine practice, the compliance balloons commonly used lack length markers, making it challenging to accurately position the balloon catheter at the optimal measurement location. R\u0026ouml;ssle et al.\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e revealed that FVHP measurement highly depends on catheter tip position and vein morphology.\u003c/p\u003e \u003cp\u003eTherefore, we designed this study with the aim of assessing (1) weather IVCP can replace FHVP in calculating HVPG and (2) When FHVP-ICVP is greater than 2 mmHg, should IVCP or FHVP be used to calculate HVPG?\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePatients\u003c/h2\u003e \u003cp\u003e This retrospective study was approved by the institutional review board, and written informed consent to participate in the study was obtained from each patient. The study included 150 consecutive HVPG measurements obtained during TIPS creation from 2020 to 2022. Exclusion criteria were: non-sinusoidal portal hypertension; imaging confirmation of complete occlusive portal vein thrombosis (PVT); severe acities. According to the inclusion and exclusion criteria, 112 patients were eligible for this study (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).We divided patients into Group A if the difference between IVCP and FHVP was greater than 2 mmHg, and into Group B if the difference was less than 2 mmHg.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMeasurement of HVPG and PPG\u003c/h3\u003e\n\u003cp\u003eBefore the procedure, contrast-enhanced 64-slice spiral computed tomography (CT) venography and vascular ultrasound were conducted to assess the patency of the IVC, HV, intrahepatic portal vein, and jugular vein. Additionally, CT venography was used to diagnose portosystemic shunt and ascites.\u003c/p\u003e \u003cp\u003eAfter accessing the jugular vein, the pressure of the right atrium and IVC was measured using a 4F pigtail catheter (Cook Medical, Bloomington, Indiana). Subsequently, a 4F Cobra catheter (Cook Medical) was utilized to catheterize the hepatic vein. This catheter was then replaced with a compliant 5.5F Fogarty balloon catheter (Edwards Lifesciences, Irvine, California), which was connected to a pressure transducer. The tip of the balloon catheter was positioned approximately 1\u0026ndash;3 cm from the IVC in the right or middle hepatic vein\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eZero adjustment of the transducer was conducted at the level of the right atrium. FHVP was measured while the balloon was deflated and allowed to float freely in the HV. Subsequently, the balloon was inflated with dilute contrast medium until complete occlusion of the target vein, and WHVP was obtained. Venography of the occluded hepatic vein was performed by using a power injector to inject 5 mL of iopromide contrast medium (Ultravist 300; Bayer AG, Leverkusen, Germany) at a rate of 2 mL/s to confirm total occlusion of the balloon at the end of the WHVP measurement. FHVP and WHVP measurements were repeated at least three times using one or two different hepatic veins, and the results were averaged.\u003c/p\u003e \u003cp\u003eThe 4F pigtail catheter (Cook Medical) was introduced into the main portal vein immediately after successful puncture using the RUPS-100 system (Cook Medical). Direct portal venous pressure was then measured prior to stent placement. The measurement duration was 1 minute, during which stable values were recorded for each part. F-HVPG was calculated by subtracting FHVP from WHVP. I-HVPG was calculated by subtracting IVCP from WHVP. The PPG was defined as the difference between PVP and IVCP.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eStatistical analysis was conducted using IBM SPSS Version 20.0 software (IBM Corp, Armonk, New York). Continuous variables conforming to the normal distribution were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, and comparisons between groups were conducted using independent sample or paired sample t-tests. Continuous variables not conforming to the normal distribution were represented by the median (25th to 75th percentiles). Paired t-tests were used for self-comparisons before and after the intervention, and comparisons between groups were performed using the Mann-Whitney U test or the Kruskal-Wallis test. The correlations between pairs of variables were analyzed using Pearson\u0026rsquo;s correlation tests to estimate Pearson\u0026rsquo;s correlation coefficients (r) and the determination coefficients (R\u003csup\u003e2\u003c/sup\u003e). Consistency was assessed using Bland\u0026ndash;Altman method. The smaller the range of 95% limits of agreement (LoA) is, the better the agreement. The level of statistical significance was set at \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003ePatient characteristics\u003c/h2\u003e \u003cp\u003eAccording to the inclusion and exclusion criteria, 112 patients were eventually enrolled in this study. Hepatitis B virus infection was the predominant etiology of cirrhosis (89.3%). The majority of patients undergoing TIPS were indicated for gastrointestinal hemorrhage (80.4%), while a small portion is for ascites (19.6%).There was no significant difference in baseline characteristics between two groups except for liver stiffness value (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The baseline characteristics of the patients are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.During HVPG Measurement and TIPS Creation, only the FHVP of group A was significantly higher than that of group B.Mean Pressures of Each Part during HVPG Measurement and TIPS Creation are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline Characteristics of Patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;112\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup A\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;18\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGroup B\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;94\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP value\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e54\u0026thinsp;\u0026plusmn;\u0026thinsp;13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e52\u0026thinsp;\u0026plusmn;\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e50\u0026thinsp;\u0026plusmn;\u0026thinsp;11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.882\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003cp\u003eMale\u003c/p\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81 (72.3%)\u003c/p\u003e \u003cp\u003e31 (27.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (77.8%)\u003c/p\u003e \u003cp\u003e4 (22.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67 (71.3%)\u003c/p\u003e \u003cp\u003e27 (28.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.350\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChild-Turcotte-Pugh score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e6.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e6.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e6.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.281\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndications\u003c/p\u003e \u003cp\u003eGastrointestinal hemorrhage\u003c/p\u003e \u003cp\u003eAscites\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e90 (80.4%)\u003c/p\u003e \u003cp\u003e22 (19.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (72.2%)\u003c/p\u003e \u003cp\u003e5 (27.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e74 (78.7%)\u003c/p\u003e \u003cp\u003e17 (18.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.427\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEtiology\u003c/p\u003e \u003cp\u003eHBV\u003c/p\u003e \u003cp\u003eHCV\u003c/p\u003e \u003cp\u003eALC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100 (89.3%)\u003c/p\u003e \u003cp\u003e7 (6.25%)\u003c/p\u003e \u003cp\u003e5 (4.46%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (94.4%)\u003c/p\u003e \u003cp\u003e1 (5.6%)\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e83 (88.3%)\u003c/p\u003e \u003cp\u003e6 (6.4%)\u003c/p\u003e \u003cp\u003e5 (5.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.222\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal bilirubin,\u0026micro;mol/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e19.8\u0026thinsp;\u0026plusmn;\u0026thinsp;8.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e22.2\u0026thinsp;\u0026plusmn;\u0026thinsp;10.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e18.5\u0026thinsp;\u0026plusmn;\u0026thinsp;8.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.207\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eALT, U/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e19.3\u0026thinsp;\u0026plusmn;\u0026thinsp;17.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e22.0\u0026thinsp;\u0026plusmn;\u0026thinsp;17.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e19.5\u0026thinsp;\u0026plusmn;\u0026thinsp;16.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.078\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAST, U/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e30.6\u0026thinsp;\u0026plusmn;\u0026thinsp;18.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e31.3\u0026thinsp;\u0026plusmn;\u0026thinsp;18.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e30.3\u0026thinsp;\u0026plusmn;\u0026thinsp;17.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.094\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlbumin, g/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e37.4\u0026thinsp;\u0026plusmn;\u0026thinsp;5.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e35.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e38.5\u0026thinsp;\u0026plusmn;\u0026thinsp;6.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.440\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSCr, \u0026micro;mol/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e77.8\u0026thinsp;\u0026plusmn;\u0026thinsp;24.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e75.4\u0026thinsp;\u0026plusmn;\u0026thinsp;28.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e77.4\u0026thinsp;\u0026plusmn;\u0026thinsp;25.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.798\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePT, s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e14.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e14.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e14.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.834\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlatelet count,10\u003csup\u003e9\u003c/sup\u003e/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e66.1\u0026thinsp;\u0026plusmn;\u0026thinsp;37.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e67.2\u0026thinsp;\u0026plusmn;\u0026thinsp;35.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e65.8\u0026thinsp;\u0026plusmn;\u0026thinsp;37.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.891\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInternational normalized ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e1.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.056\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMELD score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e10.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e10.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e9.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.087\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiver stiffness value ,kPa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e15.8\u0026thinsp;\u0026plusmn;\u0026thinsp;5.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e16.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e15.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eNote\u0026ndash;Values are reported as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD or n (%).\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eAbbreviations: HBV\u0026thinsp;=\u0026thinsp;hepatitis B virus\u0026ndash;related cirrhosis; HCV\u0026thinsp;=\u0026thinsp;hepatitis C virus\u0026ndash;related cirrhosis;\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eALC\u0026thinsp;=\u0026thinsp;alcoholic liver cirrhosis;ALT\u0026thinsp;=\u0026thinsp;alanine transaminase; AST\u0026thinsp;=\u0026thinsp;aspartate transaminase; PT\u0026thinsp;=\u0026thinsp;prothrombin time; SCr\u0026thinsp;=\u0026thinsp;serum creatinine; MELD\u0026thinsp;=\u0026thinsp;model for end-stage liver disease.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean Pressures of Each Part during HVPG Measurement and TIPS Creation\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;112\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup A\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;18\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGroup B\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;94\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP value\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIVCP, mmHg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e5.21\u0026thinsp;\u0026plusmn;\u0026thinsp;2.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e6.02\u0026thinsp;\u0026plusmn;\u0026thinsp;3.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e5.44\u0026thinsp;\u0026plusmn;\u0026thinsp;2.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.294\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFHVP, mmHg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e6.31\u0026thinsp;\u0026plusmn;\u0026thinsp;3.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e9.86\u0026thinsp;\u0026plusmn;\u0026thinsp;4.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e5.27\u0026thinsp;\u0026plusmn;\u0026thinsp;2.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWHVP,mmHg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e22.82\u0026thinsp;\u0026plusmn;\u0026thinsp;6.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e25.00\u0026thinsp;\u0026plusmn;\u0026thinsp;7.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e22.40\u0026thinsp;\u0026plusmn;\u0026thinsp;6.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.227\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePVP, mmHg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e26.64\u0026thinsp;\u0026plusmn;\u0026thinsp;6.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e28.56\u0026thinsp;\u0026plusmn;\u0026thinsp;7.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e26.66\u0026thinsp;\u0026plusmn;\u0026thinsp;6.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.042\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF-HVPG,mmHg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e16.51\u0026thinsp;\u0026plusmn;\u0026thinsp;6.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e15.94\u0026thinsp;\u0026plusmn;\u0026thinsp;6.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e16.97\u0026thinsp;\u0026plusmn;\u0026thinsp;6.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.266\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI-HVPG,mmHg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e17.62\u0026thinsp;\u0026plusmn;\u0026thinsp;6.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e20.11\u0026thinsp;\u0026plusmn;\u0026thinsp;7.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e17.14\u0026thinsp;\u0026plusmn;\u0026thinsp;6.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.041\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePPG, mmHg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e21.44\u0026thinsp;\u0026plusmn;\u0026thinsp;6.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e23.67\u0026thinsp;\u0026plusmn;\u0026thinsp;6.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e21.39\u0026thinsp;\u0026plusmn;\u0026thinsp;6.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.580\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eAbbreviations: FHVP: free hepatic venous pressure; HVPG: hepatic venous pressure gradient; IVCP: inferior vena cava pressure; PPG: portal venous pressure gradient; PVP: portal venous pressure; TIPS: transjugular intrahepatic portosystemic shunt; WHVP: wedged hepatic venous pressure.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eRelationship between IVCP and FHVP, I-HVPG and F-HVPG, I-HVPG and PPG, F-HVPG and PPG in all patients\u003c/b\u003e \u003c/p\u003e \u003cp\u003eAmong all patients (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e2\u003c/span\u003ea), the mean IVCP was similar to FHVP (5.21\u0026thinsp;\u0026plusmn;\u0026thinsp;2.84 mmHg vs 6.31\u0026thinsp;\u0026plusmn;\u0026thinsp;3.78 mmHg, \u003cem\u003eP\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.43),with a correlation coefficient of 0.835 and a coefficient of determination of 0.697 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The range of 95% LoA between IVCP and FHVP was from (-2.84) to 3.98 mmHg (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The mean I-HVPG was higher than F-HVPG (17.62\u0026thinsp;\u0026plusmn;\u0026thinsp;6.69 mmHg vs 16.51\u0026thinsp;\u0026plusmn;\u0026thinsp;6.64 mmHg, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01), with a correlation coefficient of 0.946 and a coefficient of determination of 0.895 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The range of 95% LoA between I-HVPG and F-HVPG was from (-4.86)\u0026thinsp;~\u0026thinsp;3.59 mmHg (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRelationship between IVCP and FHVP, HVPG-free and I-HVPG, HVPG-free and PPG, I-HVPG and PPG from all patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026minus;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eR\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP-\u003c/em\u003evalue\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e95% LoA (mmHg)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIVCP/FHVP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.835\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.697\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c5\"\u003e \u003cp\u003e(-2.84)\u0026thinsp;~\u0026thinsp;3.98\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF-HVPG/I-HVPG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.946\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.895\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c5\"\u003e \u003cp\u003e(-4.86)\u0026thinsp;~\u0026thinsp;3.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF-HVPG/PPG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.667\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.445\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c5\"\u003e \u003cp\u003e(-15.14)\u0026thinsp;~\u0026thinsp;5.28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI-HVPG/PPG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.698\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.487\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c5\"\u003e \u003cp\u003e(-13.61)\u0026thinsp;~\u0026thinsp;5.97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eAbbreviations: FHVP: free hepatic venous pressure; HVPG: hepatic venous pressure gradient; IVCP: inferior vena cava pressure; PPG: portal venous pressure gradient; PVP: portal venous pressure; TIPS: transjugular intrahepatic portosystemic shunt; WHVP: wedged hepatic venous pressure. LoA, limits of agreement; r: Pearson\u0026rsquo;s correlation; R\u003csup\u003e2\u003c/sup\u003e: the coefficient of determination\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAmong all patients (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e2\u003c/span\u003eb), the mean PPG(21.44\u0026thinsp;\u0026plusmn;\u0026thinsp;6.08 mmHg) was both higher than I-HVPG and F-HVPG and the differences were statistically significant( \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05)(Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The r and R\u003csup\u003e2\u003c/sup\u003e values of F-HVPG and PPG were 0.667 and 0.445, respectively (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). The range of 95% LoA between F-HVPG and PPG was from (-15.14)\u0026thinsp;~\u0026thinsp;5.28 mmHg (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The r and R\u003csup\u003e2\u003c/sup\u003e values of I-HVPG and PPG were 0.698 and 0.487, respectively (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). The range of 95% LoA between I-HVPG and PPG was from (-13.61)\u0026thinsp;~\u0026thinsp;5.97 mmHg (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003eRelationship between IVCP and FHVP, I-HVPG and F-HVPG, I-HVPG and PPG, F-HVPG and PPG in Group A\u003c/b\u003e \u003c/p\u003e \u003cp\u003eIn the Group A, The mean IVCP was lower than FHVP (6.02\u0026thinsp;\u0026plusmn;\u0026thinsp;3.36 mmHg vs 11.06\u0026thinsp;\u0026plusmn;\u0026thinsp;4.78 mmHg, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with a correlation coefficient of 0.777 and a coefficient of determination of 0.603 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002). The range of 95% LoA between IVCP and FHVP was from 0.22 to 12.11 mmHg (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The mean I-HVPG was higher than F-HVPG(20.11\u0026thinsp;\u0026plusmn;\u0026thinsp;7.19 mmHg vs 13.94\u0026thinsp;\u0026plusmn;\u0026thinsp;6.62 mmHg, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001),with a correlation coefficient of 0.907 and a coefficient of determination of 0.822 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The range of 95% LoA between F-HVPG and I-HVPG was from (-12.11) to 0.21 mmHg (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRelationship between IVCP and FHVP, HVPG-free and I-HVPG, HVPG-free and PPG, I-HVPG and PPG from group A and group B\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eGroup A\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e \u003cp\u003eGroup B\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eR\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e95%LoA (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eR\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e95%LoA (mmHg)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIVCP/FHVP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.777\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.603\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.22\u0026thinsp;~\u0026thinsp;12.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.991\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.982\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e(-0.57)\u0026thinsp;~\u0026thinsp;0.91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF-HVPG/I-HVPG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.907\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.822\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(-12.11)\u0026thinsp;~\u0026thinsp;0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.998\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.997\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e(-0.91)\u0026thinsp;~\u0026thinsp;0.57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF-HVPG/PPG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.648\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.420\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(-18.37)\u0026thinsp;~\u0026thinsp;2.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.683\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.466\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e(-14.36)\u0026thinsp;~\u0026thinsp;5.51\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI-HVPG/PPG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.807\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.651\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(-9.93)\u0026thinsp;~\u0026thinsp;6.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.684\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.468\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e(-14.10)\u0026thinsp;~\u0026thinsp;5.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eAbbreviations: FHVP: free hepatic venous pressure; HVPG: hepatic venous pressure gradient; IVCP: inferior vena cava pressure; PPG: portal venous pressure gradient; PVP: portal venous pressure; TIPS: transjugular intrahepatic portosystemic shunt; WHVP: wedged hepatic venous pressure. LoA, limits of agreement; r: Pearson\u0026rsquo;s correlation; R\u003csup\u003e2\u003c/sup\u003e: the coefficient of determination\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn the Group A (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e3\u003c/span\u003e), the mean PPG (21.67\u0026thinsp;\u0026plusmn;\u0026thinsp;6.31 mmHg) was both higher than I-HVPG and F-HVPG and the differences were statistically significant(\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01)(Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The r and R\u003csup\u003e2\u003c/sup\u003e values of F-HVPG and PPG were 0.648 and 0.420, respectively((\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004). The range of 95% LoA between F-HVPG and PPG was from (-18.37)\u0026thinsp;~\u0026thinsp;2.92 mmHg (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The r and R\u003csup\u003e2\u003c/sup\u003e values of I-HVPG and PPG were 0.807 and 0.651, respectively (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). The range of 95% LoA between I-HVPG and PPG was from (-9.93)\u0026thinsp;~\u0026thinsp;6.82 mmHg (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eRelationship between IVCP and FHVP, I-HVPG and F-HVPG, I-HVPG and PPG, F-HVPG and PPG in Group B\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eI\u003c/span\u003en the Group B (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e4\u003c/span\u003ea), The mean IVCP was similar to FHVP (5.44\u0026thinsp;\u0026plusmn;\u0026thinsp;2.79 mmHg vs 5.27\u0026thinsp;\u0026plusmn;\u0026thinsp;2.74 mmHg, \u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.673), with a correlation coefficient of 0.991 and a coefficient of determination of 0.982\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). The range of 95% LoA between IVCP and FHVP was from (-0.57)\u0026thinsp;~\u0026thinsp;0.91 mmHg (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The mean I-HVPG was also similar to F-HVPG(16.97\u0026thinsp;\u0026plusmn;\u0026thinsp;6.60 mmHg vs 17.14\u0026thinsp;\u0026plusmn;\u0026thinsp;6.53 mmHg, \u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.859),with a correlation coefficient of 0.998 and a coefficient of determination of 0.997 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). The range of 95% LoA between F-HVPG and I-HVPG was from (-0.91)\u0026thinsp;~\u0026thinsp;0.57 mmHg (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIn the Group B (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e4\u003c/span\u003eb), the mean PPG (21.39\u0026thinsp;\u0026plusmn;\u0026thinsp;6.07 mmHg) was both higher than I-HVPG and F-HVPG ( \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The r and R\u003csup\u003e2\u003c/sup\u003e values of F-HVPG and PPG were 0.683 and 0.466, respectively (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). The range of 95% LoA between F-HVPG and PPG was from (-14.36)\u0026thinsp;~\u0026thinsp;5.51 mmHg (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The r and R\u003csup\u003e2\u003c/sup\u003e values of I-HVPG and PPG were 0.684 and 0.468, respectively (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). The range of 95% LoA between I-HVPG and PPG was from (-14.10)\u0026thinsp;~\u0026thinsp;5.59 mmHg (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStratification of portal hypertension\u003c/h2\u003e \u003cp\u003eAmong all patients, the area under curves of F-HVPG and I-HVPG were 0.687 and 0.693 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) forstratifying PHT of 16 mmHg and 0.623 and 0.644(p\u0026thinsp;=\u0026thinsp;0.001) for stratifying PHT of 20 mmHg. In the Group A, the area under curves of F-HVPG and I-HVPG were 0.582 and 0.867 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) forstratifying PHT of 16 mmHg and 0.540 and 0.831 (p\u0026thinsp;=\u0026thinsp;0.001) for stratifying PHT of 20 mmHg.\u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eIn this study aiming to explore whether IVCP can be used instead of FHVP to calculate HVPG, we found that when FHVP-IVCP\u0026thinsp;\u0026gt;\u0026thinsp;2 mmHg, I-HVPG could better define PPG. Our data also suggested that high correlation and consistency were found between I-HVPG and F-HVPG.\u003c/p\u003e \u003cp\u003eThe most common cause of cirrhosis in China is viral hepatitis B infection\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. Patients with sinusoidal cirrhosis, with an HVPG\u0026thinsp;\u0026ge;\u0026thinsp;10 mmHg(CSPH), are considered to have a significantly increased probability of decompensated events such as ascites, bleeding, and hepatic encephalopathy\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e.Thus, the measurement of HVPG is of great importance.\u003c/p\u003e \u003cp\u003eThe accuracy of HVPG highly depends on the accuracy of the technique\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e.However, in clinical practice, the compliant balloon used lacks length markings, making it difficult to precisely position the balloon catheter at the optimal measurement location. R\u0026ouml;ssle et al.\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e pointed out that due to the conical shape of the hepatic vein, the measurement of free hepatic venous pressure strongly relies on the position of the measuring catheter tip. They suggested that an 8-French catheter (diameter 2.4 mm), regardless of the position of the catheter tip, would cause 20% or more obstruction in small hepatic veins with a diameter of 6 mm, leading to a falsely elevated FHVP by 20%. In decompensated cirrhotic patients undergoing HVPG measurements, hepatic veins are typically atrophic and narrowed to varying degrees, which exacerbates this error. As a result, HVPG will be far lower than the true value, failing to reflect the actual PPG.\u003c/p\u003e \u003cp\u003eHiang Keat Tan et al.\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e conducted a similar study, suggesting that when FHVP is recorded at a position further away from the junction of the hepatic vein (HV) and IVC, it is likely due to relative obstruction of the catheter or gradual wedging into narrower hepatic veins, leading to falsely elevated FHVP measurements. This false elevation of FHVP significantly affects the accuracy and effectiveness of HVPG. Since IVCP is not influenced by changes in catheter position, the difference between FHVP and IVCP will increase when measured from the proximal to distal positions of the hepatic vein. In our study, among the 18 patients with FHVP-IVCP differences greater than 2 mmHg, I-HVPG showed better correlation and consistency with PPG.While the correlation and consistency between F-HVPG and PPG were statistically significant, with the increase in FHVP, there was a corresponding decrease in HVPG, which could not reflect the true PPG.Moreover, in patients with FHVP-IVCP differences greater than 2 mmHg, I-HVPG possessed a better ability to stratify PHT of 16 mmHg and 20 mmHg than that of F-HVPG (0.582 vs 0.867, 0.540 vs 0.831). It means that using I-HVPG can reduce the misdiagnosis rate of severe PHT significantly.\u003c/p\u003e \u003cp\u003eSilva-Junior et al.\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e suggested that I-HVPG showed poor significance in predicting survival without liver transplantation, thus strongly advising against using IVCP to calculate HVPG under any circumstances. Among the patients included in his study, 85.3% were infected with HCV and suffered from alcoholic cirrhosis, and the causes of the remaining 14.7% were not specified; in addition, no description was given about whether the patients were in the compensated or decompensated stage of liver cirrhosis. In our study, all patients were in the decompensated stage with sinusoidal cirrhosis. Therefore, using IVCP to calculate HVPG in clinical practice is advisable.\u003c/p\u003e \u003cp\u003eThe measurement of venous pressure is influenced by many factors\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e, such as the use of some drugs (e.g., Propranolol), the presence of large amounts of ascites, and deep anesthesia. To avoid such influences, all of our measurements were performed under local anesthesia using the standardized method described previously and the patients with severe ascities were excluded.\u003c/p\u003e \u003cp\u003eThis study has several limitations: First, we did not know the cause of the elevated FHVP, which requires further study with more case samples;Second, only decompensated cirrhotic patients with sinusoidal PHT were enrolled. Further study will explore the value of I-HVPG in patients with non-sinusoidal PHT. Third, this was a retrospective study, using records from a single medical center. Further research is needed to validate the results using larger sample sizes and prospective studies.\u003c/p\u003e \u003cp\u003eIn summary, F-HVPG and I-HVPG exhibited high correlation and consistency, making the use of IVCP to calculate HVPG preferable in clinical practice. When the difference between FHVP and IVCP exceeds 2 mmHg, HVPG might greatly underestimate the actual PVP value. IVCP should be used to calculate HVPG rather than FHVP.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cul type=\"disc\"\u003e\n \u003cli\u003eDSA: digital subtraction angiography\u003c/li\u003e\n \u003cli\u003eFHVP: free hepatic venous pressure\u003c/li\u003e\n \u003cli\u003eWHVP: wedged hepatic venous pressure\u003c/li\u003e\n \u003cli\u003eHVPG: hepatic venous pressure gradient\u003c/li\u003e\n \u003cli\u003eIVCP: inferior vena cava pressure\u003c/li\u003e\n \u003cli\u003ePPG: portal venous pressure gradient\u003c/li\u003e\n \u003cli\u003ePVP: portal venous pressure\u003c/li\u003e\n \u003cli\u003eTIPS: transjugular intrahepatic portosystemic shunt\u003c/li\u003e\n \u003cli\u003eNSBBs: nonselective \u0026beta;-blockers\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis study was supported by grants from Device development exploration project from National Clinical Research Center for Interventional Medicine (2021-001), Shanghai key clinical specialty construction program (W2019028), Excellent youth program from Zhongshan Hospital, Fudan University (2019ZSYXQN38) and Clinical research special fund from Zhongshan Hospital, Fudan University (2018ZSLC23).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eJL and JM contributed to the study\u0026rsquo;s conception and design. Material preparation and data collection were performed by RC, JM, WZ, MY, YL, JY, JL, YZ and ZY. Data analysis and interpretation were performed by LM, JM, WZ and JL. The first draft of the manuscript was written by RC and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eData availability\u003c/h2\u003e \u003cp\u003eData available on request from the authors.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGin\u0026egrave;s P, Krag A, Abraldes JG, Sol\u0026agrave; E, Fabrellas N, Kamath PS. Liver cirrhosis. Lancet. 2021;398(10308):1359\u0026ndash;76.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDe Franchis R, Bosch J, Garcia-Tsao G, Reiberger T, Ripoll C, Abraldes JG, et al. Baveno VII \u0026ndash; Renewing consensus in portal hypertension. J Hepatol. 2022;76(4):959\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDittrich S, De Mattos AA, Becker M, Gon\u0026ccedil;aves DM, Cheinquer H. Role of Hepatic Hemodynamic Study in the Evaluation of Patients with Cirrhosis. Hepatogastroenterology. 2003;50(54):2052\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGroszmann R, Vorobioff JD, Gao H. Measurement of Portal Pressure: When, How, and Why to Do It. Clin Liver Dis. 2006;10(3):499\u0026ndash;512.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGroszmann RJ, Glickman M, Blei AT, Storer E, Conn HO. Wedged and free hepatic venous pressure measured with a balloon catheter. Gastroenterology. 1979;76(2):253\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBoike JR, Thornburg BG, Asrani SK, Fallon MB, Fortune BE, Izzy MJ, et al. North American Practice-Based Recommendations for Transjugular Intrahepatic Portosystemic Shunts in Portal Hypertension. Clin Gastroenterol Hepatol. 2022;20(8):1636\u0026ndash;e166236.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRipoll C, Groszmann R, Garcia G, Grace N, Burroughs A, Planas R et al. Hepatic Venous Pressure Gradient Predicts Clinical Decompensation in Patients With. Compensated Cirrhosis. 2007;133(2).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim TY, Lee JG, Sohn JH, Kim JY, Kim SM, Kim J, et al. Hepatic Venous Pressure Gradient Predicts Long-Term Mortality in Patients with Decompensated Cirrhosis. Yonsei Med J. 2016;57(1):138\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGroszmann RJ, Wongcharatrawee S. The hepatic venous pressure gradient: anything worth doing should be done right. Hepatology. 2004;39(2):280\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLa Mura V, Abraldes JG, Berzigotti A, Erice E, Flores-Arroyo A, Carlos Garc\u0026iacute;a-Pag\u0026aacute;n J, et al. Right atrial pressure is not adequate to calculate portal pressure gradient in cirrhosis: A clinical-hemodynamic correlation study. Hepatology. 2010;51(6):2108\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKumar A, Sharma P, Sarin SK. Hepatic venous pressure gradient measurement: Time to learn! Indian J Gastroenterol. 2008;27(2):74\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBusch K, Thimme R. Natural history of chronic hepatitis B virus infection. Med Microbiol Immunol. 2015;204(1):5\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eD\u0026rsquo;Amico G, Morabito A, D\u0026rsquo;Amico M, Pasta L, Malizia G, Rebora P, et al. New concepts on the clinical course and stratification of compensated and decompensated cirrhosis. Hepatol Int. 2018;12(S1):34\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLa Mura V, Garcia-Guix M, Berzigotti A, Abraldes JG, Garc\u0026iacute;a‐Pag\u0026aacute;n JC, Villanueva C, et al. A Prognostic Strategy Based on Stage of Cirrhosis and HVPG to Improve Risk Stratification After Variceal Bleeding. Hepatology. 2020;72(4):1353\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMagaz M, Baiges A, Hern\u0026aacute;ndez-Gea V. Precision medicine in variceal bleeding: Are we there yet? J Hepatol. 2020;72(4):774\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eR\u0026ouml;ssle M, Blanke P, Fritz B, Schultheiss M, Bettinger D. Free Hepatic Vein Pressure Is Not Useful to Calculate the Portal Pressure Gradient in Cirrhosis: A Morphologic and Hemodynamic Study. J Vasc Interv Radiol. 2016;27(8):1130\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTan HK, Tan AB, Teh KKJ, Gogna A, Too CW, Leong S, et al. Impact of catheter tip to hepatic vein ostium distance on the validity and prognostication of hepatic venous pressure gradient in cirrhosis. Sci Rep. 2023;13(1):16980.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSilva-Junior G, Baiges A, Turon F, Torres F, Hern\u0026aacute;ndez‐Gea V, Bosch J, et al. The prognostic value of hepatic venous pressure gradient in patients with cirrhosis is highly dependent on the accuracy of the technique. Hepatology. 2015;62(5):1584\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlvarado-Tapias E, Ardevol A, Garcia-Guix M, Monta\u0026ntilde;\u0026eacute;s R, Pavel O, Cuyas B, et al. Short-term hemodynamic effects of β-blockers influence survival of patients with decompensated cirrhosis. J Hepatol. 2020;73(4):829\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMandell MS, Durham J, Kumpe D, Trotter JF, Everson GT, Niemann CU. The Effects of Desflurane and Propofol on Portosystemic Pressure in Patients with Portal Hypertension. Anesth Analgesia. 2003;97(6):1573.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSteinlauf AF, Garcia-Tsao G, Zakko MF, Dickey K, Gupta T, Groszmann RJ. Low-dose midazolam sedation: An option for patients undergoing serial hepatic venous pressure measurements. Hepatology. 1999;29(4):1070\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"portal hypertension, inferior vena cava pressure, portal pressure gradient, hepatic venous pressure gradient, transjugular intrahepatic portosystemic shunt (TIPS)","lastPublishedDoi":"10.21203/rs.3.rs-5297383/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5297383/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e: To evaluate the correlation and consistency between hepatic venous pressure gradient(F-HVPG) calculated as the wedged hepatic venous pressure (WHVP) minus free hepatic venous pressure (FHVP), I-HVPG calculated as WHVP minus inferior vena cava pressure (IVCP) in the hepatic segment, and portal pressure gradient (PPG).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: Data were collected from 112 patients with portal hypertension undergoing transjugular intrahepatic portosystemic shunt (TIPS) along with HVPG measurement. FHVP, IVCP, WHVP, and portal venous pressure (PVP) were collected intraoperatively. Pearson’s correlation and Bland–Altman method were used to assess correlation and consistency.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e:A total of 112 patients were retrospectively collected. The correlation coefficient (r) velues (\u003cem\u003ep \u003c/em\u003e\u0026lt; 0.001) between FHVP and IVCP, F-HVPG and I-HVPG, F-HVPG and PPG, I-HVPG and PPG were 0.835, 0.946, 0.667 and 0.698, respectively; the determination coefficient (R\u003csup\u003e2\u003c/sup\u003e) values were 0.697, 0.895, 0.445 and 0.487, respectively. Bland–Altman plots showed that F-HVPG and I-HVPG had the narrowest 95% limits of agreement. Among patients with FHVP-IVCP \u0026gt; 2 mmHg, the (r) vlues (\u003cem\u003ep \u003c/em\u003e\u0026lt; 0.05) between F-HVPG and I-HVPG, F-HVPG and PPG,I-HVPG and PPG were 0.907, 0.648 and 0.807, respectively; the (R\u003csup\u003e2\u003c/sup\u003e) values were 0.822, 0.420 and 0.651, respectively. Bland–Altman plots showed that I-HVPG had the narrower 95% limits of agreement with PPG.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: F-HVPG and I-HVPG demonstrated high correlation and consistency. When the difference between FHVP and IVCP is greater than 2 mmHg, IVCP should be used to calculate HVPG instead of FHVP.\u003c/p\u003e","manuscriptTitle":"Correlation and Consistency Analysis between Various Indirect Portal Pressure Gradients and Actual Portal Pressure Gradient","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-11 05:31:03","doi":"10.21203/rs.3.rs-5297383/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-06T14:24:54+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-10-23T01:58:03+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-10-23T01:56:28+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Gastroenterology","date":"2024-10-20T08:07:20+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8ad0dd0a-bc48-4894-bae3-5af4586fe291","owner":[],"postedDate":"November 11th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-04-14T16:14:36+00:00","versionOfRecord":{"articleIdentity":"rs-5297383","link":"https://doi.org/10.1186/s12876-025-03816-z","journal":{"identity":"bmc-gastroenterology","isVorOnly":false,"title":"BMC Gastroenterology"},"publishedOn":"2025-04-10 16:05:23","publishedOnDateReadable":"April 10th, 2025"},"versionCreatedAt":"2024-11-11 05:31:03","video":"","vorDoi":"10.1186/s12876-025-03816-z","vorDoiUrl":"https://doi.org/10.1186/s12876-025-03816-z","workflowStages":[]},"version":"v1","identity":"rs-5297383","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5297383","identity":"rs-5297383","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}