Comparison of the diagnostic efficacy between virtual portal pressure gradient and hepatic venous pressure gradient in patients with cirrhotic portal hypertension

Objectives This study aimed to evaluate the performance of virtual portal pressure gradient (vPPG) and its associated hemodynamic parameters of 3‐dimensional (3D) model in patients with cirrhosis. Methods Seventy cirrhotic patients who underwent both hepatic venous pressure gradient (HVPG) measurement and vPPG calculation were prospectively collected. The ideal‐state model (ISM; n = 44) was defined by sinusoidal PH without hepatic vein shunt or portal vein thrombosis, whereas those not conforming to the criteria were classified as non‐ISM (n = 26). Correlation analyses were conducted to determine the relationship between vPPG or its associated 3D hemodynamic parameters and HVPG. The diagnostic and predictive performance of vPPG and HVPG for cirrhotic‐related complications was evaluated using the receiver operating characteristic (ROC) curve and Kaplan–Meier analysis. Results In the ISM group, vPPG‐associated hemodynamic parameters including total branch cross‐sectional area (S2), average branch cross‐sectional area (S), and average portal vein model length (h) were correlated with HVPG ( r = 0.592, 0.536, −0.497; all p < 0.001), whereas vPPG was strongly correlated with HVPG ( r = 0.832, p < 0.001). In the non‐ISM group, vPPG, S2, S, and h were not related to HVPG (all p > 0.05). In the ISM group, both vPPG and HVPG showed significant diagnostic and predictive capabilities for cirrhosis‐related complications. While in the non‐ISM group, the diagnostic accuracy and predictive efficacy of vPPG surpassed those of HVPG. Conclusion HVPG exhibited superior diagnostic and predictive efficacy for cirrhotic PH in the ISM, whereas vPPG showed enhanced performance in non‐ISM.