Transient Elastography as Non Invasive Assessment of Portal Hypertension in Advanced Chronic Liver Disease
Keywords:
Portal hypertension, Hepatic venous pressure gradient, transient elastography, chronic liver diseaseAbstract
Background: Hepatic cirrhosis (HC) is the most frequent source of clinically significant portal hypertension (CSPH) in Western countries. A reliable, easy-to-use, and noninvasive tool to assess for the presence of CSPH for screening of cirrhotic patients is needed. Aims: 1) To determine the correlation between liver stiffness (LS), measured by transient elastography (TE) and portal hypertension (PH), by hepatic venous pressure gradient(HVPG), as well as the cut off value of TE for CSPH; 2) To evaluate the correlation between CSPH and LS with the histological findings in liver biopsy; 3) To assess the relationship between the degree of LS and the risk of clinical decompensation in HC. Methods: Single center, prospective, cohort study. 58 in-and-out-patients with chronic liver diseases were enrolled during a 40-month period. Results: A statistically significant association between LS (TE), and PH (HVPG) was found (r = 0.71, p < 0.0001). Cut off value of TE for diagnosis of CSPH was 17.15 kPa. Using this cut-off, 81% of the patients presented CSPH while 87% using the HVPG cut-off of ≥10mmHg. Both the nodule size and septal thickening were the two independent predictors of CSPH. The probability of remaining free of developing a hepatic decompensation was significantly superior in the group of patients without CSPH (TE < 17.15 kPa, p < 0.001). Conclusions:TE is a reliable, non-invasive and affordable tool for assessing CSPH. A statistically significant association between LS measured by TE and HVPG as prognostic tool for development of CSPH in patients with chronic liver diseas
References
Friedman, SL., Rockey, DC., Bissell, DM. (2007) Hepatic fibrosis 2006. Report of the Third AASLD Single Topic Conference.Hepatology, 45(1): 242-249.
Bari, K., Garcia-Tsao, G. (2012) Treatment of portal hypertension. World J Gastroenterol, 18(11):1166-1175.
Ravaioli, F., Montagnani, M., Lisotti, A., Festi, D., Mazzella, G., Azzaroli, F. (2018) Noninvasive Assessment of Portal Hypertension in Advanced Chronic Liver Disease: An Update. Gastroenterol Res Pract, 2018:4202091.
Bureau, C., Metivier, S., Peron, JM.,Robic, MA., Gourraud, PA., Rouquet, O., et al. (2008) Transient elastography accurately predicts presence of significant portal hypertension in patients with chronic liver disease. Aliment Pharmacol Ther, 27(12): 1261–1268.
Bosch, J., Groszmann, RJ., Shah, VH. (2015) Evolution in the understanding of the pathophysiological basis of portal hypertension: How changes in paradigm are leading to successful new treatments. J Hepatol, 62( 1Suppl): S121-S130.
Garbuzenko, DV. (2015) Contemporary concepts of the medical therapy of portal hypertension under liver cirrhosis. World J Gastroenterol, 21(20): 6117-6126.
Bloom, S., Kemp, W., Lubel, J. (2015) Portal hypertension: pathophysiology, diagnosis and management. Intern Med J, 45(1): 16-26.
Vorobioff, J., Groszmann, RJ., Picabea, E., Gamen, M., Villavinceneo, R., Bordato, J., et al.(1996) Prognostic value of hepatic venous pressure gradient measurements in alcoholic cirrhosis: a 10-year prospective study. Gastroenterology, 111(3): 701-709.
You, MW., Kim, KW., Pyo, J., Huh, J., Kim, HJ., Lee, SO., et al (2017) A meta-analysis for the diagnostic performance of transient elastography for clinically significant portal hypertension. Ultrasound Med Biol, 43(1): 59–68.
Garcia-Tsao, G., Groszmann, RJ., Fisher, RL., Conn, HO., Atterbury, CE., Glickman, M. (1985) Portal pressure, presence of gastroesophageal varices and variceal bleeding. Hepatology, 5(3): 419-424.
Viallet, A., Marleau, D., Huet, M.,Martin, F., Farley, A., Villeneuve, JP., et al. (1975) Hemodynamic evaluation of patients with intrahepatic portal hypertension. Relationship between bleeding varices and the portohepatic gradient. Gastroenterology, 69(6): 1297-1300.
de Franchis, R. (2000) Updating consensus in portal hypertension: report of the Baveno III Consensus Workshop on definitions, methodology and therapeutic strategies in portal hypertension. J Hepatol, 33(5): 846-852.
Kumar, A., Khan, NM., Anikhindi, SA., Sharma, P., Bansal, N., Singla, V., et al.(2017) Correlation of transient elastography with hepatic veneus pressure gradient in patients with cirrhotic portal hypertension: A study of 326 patients from India. World J Gastroenterol, 23(4): 687-696.
Sandrin, L., Fourquet, B., Hasquenoph, JM., Yon, S., Fournier, C., Mal, F., et al. (2003) Transient elastography: a new noninvasive method for assessment of hepatic fibrosis. Ultrasound Med Biol, 29(12): 1705–1713.
Friedrich-Rust, M., Ong, MF., Martens, S.,Sarrazin, C., Bojunga, J., Zeyzem, S., et al. (2008) Performance of transient elastography for the staging of liver fibrosis: a meta-analysis. Gastroenterology, 134(4): 960–974.
Procopet, B., Berzigotti, A.,Abraldes, JG., Turon, F., Hernandez-Gea, V., Garcia-Pagan, JC., et al. (2015) Real-time shear-wave elastography: applicability, reliability and accuracy for clinically significant portal hypertension. J Hepatol, 62(5): 1068–1075.
Kim, TY., Jeong, WK., Sohn, JH., Kim, J., Kim, MY., Kim, Y.(2015) Evaluation of portal hypertension by real-time shear wave elastography in cirrhotic patients. Liver Int, 35(11):2416–2424.
Abraldes, JG., Bureau, C., Stefanescu, H., Augustin, S., Ney, M., Blasco, H., et al. (2016) Noninvasive tools and risk of clinically significant portal hypertension and varices in compensated cirrhosis: The Anticipate study. Hepatology, 64(6): 2173-2184.
Kitson, MT., Roberts, SK., Colman, JC., Paul, E., Button, P., Kemp, W. (2015) Liver stiffness and the prediction of clinically significant portal hypertension and portal hypertensive complications. Scand J Gastroenterol, 50(4): 462–469.
Sporea, I., Sirli, RL. (2012) Hepatic elastography for the assessment of liver fibrosis--present and future. Ultraschall Med, 33(6): 550-558.
Vizzutti, F., Arena, U., Romanelli, RG., Rega, L., Foschi, M., Colagrande, S., et al. (2007) Liver stiffness measurement predicts severe portal hypertension in patients with HCV- related cirrhosis. Hepatology, 45(5): 1290-1297.
Lemoine, M., Katsahian, S., Ziol, M., Nahon, P., Ganne-Carrie, N., Kazemi, F., et al. (2008) Liver stiffness measurement as a predictive tool of clinically significant portal hypertension in patients with compensated hepatitis C virus or alcohol-related cirrhosis. Aliment Pharmacol Ther, 28(9): 1102-1110.
Sánchez-Conde, M., Miralles, P., María Bellón, J., Rincón, D., Ramírez, M., Gutiérrez, I., et al. (2011) Use of transient elastography (FibroScan®) for the noninvasive assessment of portal hypertension in HIV/HCV-coinfected patients. J Viral Hepat, 18(10): 685-691.
Carrión, JA., Navasa, M., Bosch, J., Bruguera, M., Gilabert, R., Forns, X. (2006) Transient elastography for diagnosis of advanced fibrosis and portal hypertension in patients with hepatitis C recurrence after liver transplantation. Liver Transpl, 12(12): 1791-1798.
Reiberger, T., Ferlitsch, A., Payer, BA., Pinter, M., Schwabl, P., Stift, J., et al. (2012) Noninvasive screening for liver fibrosis and portal hypertension by transient elastography--a large single center experience. Wien Klin Wochenschr, 124(11-12): 395-402.
Berzigotti, A., Seijo, S., Arena, U., Abraldes, JG., Vizzutti, F., García-Pagán, JC., et al. (2013) Elastography spleen size and platelet count identify portal hypertension in patients with compensated cirrhosis. Gastroenterology, 144(1): 102-111.
Kim, G., Kim, MY., Baik, SK. (2017) Transient elastography versus hepatic venous pressure gradient for diagnosing portal hypertension: a systematic review and meta-analysis. Clin Mol Hepatol, 23(1): 34-41.
Nagula, S., Jain, D., Groszmann, RJ., Garcia Tsao, G. (2006) Histological-hemodynamic correlation in cirrhosis-a histological classification of the severity of cirrhosis. J Hepatol 44(1): 111-117.
Kumar, M., Sakhuja, P., Kumar, A., Manglik, N., Choudhury, A., Hissar, S., et al. (2008) Histological subclassification of cirrhosis based on histological haemodynamic correlation. Aliment Pharmacol Ther, 27(9): 771-779.
Rastogi, A., Maiwall, R., Bihari, C., Ahuja, A., Kumar, A., Singh, T., et al. (2013) Cirrhosis histology and Laennec staging system correlate with high portal pressure. Histopathology, 62(5): 731-741.
Dufour, JF., Greten, TF., Raymond, E., Raymond, E., Roskams, T., De Baere, T., et al. (2012) EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol, 56(4): 908-943.
Batts, KP., Ludwig, J. (1995) Chronic hepatitis. An update on terminology and reporting. Am J Surg Pathol, 19(12): 1409-1417.
Dehesa-Violante, M., Nuñez-Nateras, R. (2007) Epidemiology of hepatitis virus B and C. Arch Med Res, 38(6): 606- 611.
Sagnelli, E., Stroffolini, T., Mele, A., Almasio, P., Coppola, N., Ferrigno, L., et al. (2005) The importance of HCV on the burden of chronic liver disease in Italy: a multicenter prevalence study of 9,997 cases. J Med Virol, 75(4): 522- 527.
Llop, E., Berzigotti, A., Reig, M., Erice, E., Reverter, E., Seijo, S., et al. (2012) Assessment of portal hypertension by transient elastography in patients with compensated cirrhosis and potentially resectable liver tumors. J Hepatol, 56(1): 103-108.
Thein, HH., Yi, Q., Dore, GJ., Krahn, MD. (2008) Estimation of stage specific fibrosis progression rates in chronic hepatitis C virus infection: a meta-analysis and meta regression. Hepatology, 48(2): 418-431.
Ripoll, C., Groszmann, R., Garcia Tsao, G., Grace, N., Burroughs, A., Planas, R., et al. (2007) Hepatic venous pressure gradient predicts clinical decompensation in patients with compensated cirrhosis. Gastroenterology, 133(2): 481-488.
Foucher, J., Chanteloup, E., Vergniol, J., Castéra, L., Bail, BL., Adhoute, X., et al. (2006) Diagnosis of cirrhosis by transient elastography (FibroScan): a prospective study. Gut, 55(3): 403-408.
Klibansky, DA., Mehta, SH., Curry, M., Nasser, I., Challies, T., Afdhal, NH. (2012) Transient elastography for predicting clinical outcomes in patients with chronic liver disease. J Viral Hepat, 19(2): e184-193.
Vergniol, J., Foucher, J., Terrebonne, E., Bernard, PH., Bail, BL., Merrouche, W., et al. (2011) Noninvasive tests for fibrosis and liver stiffness predict 5year outcomes of patients with chronic hepatitis C. Gastroenterology, 140(7): 1970-1979.
Robic, MA., Procopet, B., Métivier, S., Péron, JM., Selves, J., Vinel, JP., et al. (2011) Liver stiffness accurately predicts portal hypertension related complications in patients with chronic liver disease: a prospective study. J Hepatol, 55(5): 1017-1024.
