Left Ventricular Longitudinal Contractility Predicts Acute‐on‐Chronic Liver Failure Development and Mortality After Transjugular Intrahepatic Portosystemic Shunt

Abstract

Acute deterioration of liver cirrhosis (e.g., infections, acute‐on‐chronic liver failure [ACLF]) requires an increase in cardiac contractility. The insufficiency to respond to these situations could be deleterious. Left ventricular global longitudinal strain (LV‐GLS) has been shown to reflect left cardiac contractility in cirrhosis better than other parameters and might bear prognostic value. Therefore, this retrospective study investigated the role of LV‐GLS in the outcome after transjugular intrahepatic portosystemic shunt (TIPS) and the development of ACLF. We included 114 patients (48 female patients) from the Noninvasive Evaluation Program for TIPS and Their Follow‐Up Network (NEPTUN) cohort. This number provided sufficient quality and structured follow‐up with the possibility of calculating major scores (Child, Model for End‐Stage Liver Disease [MELD], Chronic Liver Failure Consortium acute decompensation [CLIF‐C AD] scores) and recording of the events (development of decompensation episode and ACLF). We analyzed the association of LV‐GLS with overall mortality and development of ACLF in patients with TIPS. LV‐GLS was independently associated with overall mortality (hazard ratio [HR], 1.123; 95% confidence interval [CI],1.010‐1.250) together with aspartate aminotransferase (HR, 1.009; 95% CI, 1.004‐1.014) and CLIF‐C AD score (HR, 1.080; 95% CI, 1.018‐1.137). Area under the receiver operating characteristic curve (AUROC) analysis for LV‐GLS for overall survival showed higher area under the curve (AUC) than MELD and CLIF‐C AD scores (AUC, 0.688 versus 0.646 and 0.573, respectively). The best AUROC‐determined LV‐GLS cutoff was −16.6% to identify patients with a significantly worse outcome after TIPS at 3 months, 6 months, and overall. LV‐GLS was independently associated with development of ACLF (HR, 1.613; 95% CI, 1.025‐2.540) together with a MELD score above 15 (HR, 2.222; 95% CI, 1.400‐3.528). Conclusion: LV‐GLS is useful for identifying patients at risk of developing ACLF and a worse outcome after TIPS. Although validation is required, this tool might help to stratify risk in patients receiving TIPS.

Cardiodynamic state is associated with systemic inflammation and fatal acute‐on‐chronic liver failure

“…Moreover, echocardiography is widely available. Especially, more sophisticated techniques, such as speckle tracking echocardiography (STE), were shown to be able to predict ACLF development in patients with TIPS 31,32 . STE therefore seems to be a promising tool for non‐invasive assessment of cardiodynamics and its impact on ACLF development should be investigated in future studies.…”

Transjugular intrahepatic portosystemic stent-shunt in the management of portal hypertension

“…However, there remains limited data to support the utility of echocardiogram in the absence of a positive cardiac history, examination or ECG (prolonged QT interval) and NT-proBNP) prior to TIPSS. The utility of alternative echocardiographic methods of assessing cardiac function such as left ventricular global longitudinal strain remains a research area 161…”

Editorial: diastolic dysfunction seems not to be decisive for survival after transjugular intrahepatic portosystemic stent‐shunt

“…Therefore, latent cardiac dysfunction could lead to the development of organ failure, ACLF and death . This hypothesis is underlined by recent data in patients with TIPSS …”

“…Therefore, Speckle tracking might also predict transplant‐free outcome, since transplant allocation is majorly driven by renal dysfunction, but after transplantation this diagnostic tool seems not to play a further role . However, recently Speckle tracking in a large collective of patients receiving TIPSS could predict survival independently …”