Transjugular intrahepatic portosystemic shunt is associated with significant changes in mitral inflow parameters

Pudil, Radek; Praus, Rudolf; Hůlek, P; Šafka, Václav; Fejfar, Tomáš; Vašatová, Martina; Jirkovský, Václav

doi:10.1016/s1665-2681(19)31010-5

Cited by 13 publications

(17 citation statements)

References 23 publications

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“…described before, these studies were at longest limited to observations made in the first year after TIPSS and results indicated normalisation at 1 year post-TIPSS. 22,23 With regard to initial changes after TIPSS our study agreed with previous analyses of the early period post-TIPSS. 15,16,18,25 However, to build on the research established in previous studies, the follow-up in this study was extended until 5 years after TIPSS.…”

Section: Discussionsupporting

confidence: 89%

“…21 Despite the well-studied haemodynamic changes immediately after TIPSS, less is known about changes during longer follow-up periods. While one small study found progressive worsening of echocardiographic parameters within the first 180 days post-insertion, 22 another prospective evaluation suggested that initial changes normalise within the first year after TIPSS. 23 While following-up with our own TIPSS patients, we noted an unusually high rate of pulmonary hypertension (PH).…”

Section: Resultsmentioning

confidence: 98%

“…Portal haemodynamics findings at TIPSS placement Prior to TIPSS insertion, an increased PPG was found with a median of 18 mmHg (IQR: [15][16][17][18][19][20][21][22], which decreased after TIPSS placement to 8 mmHg (IQR: 6-11; P < 0.001). PVP declined from a median of 27 mmHg (IQR: 23-34) to 20 mmHg (IQR: 13-27; P = 0.001).…”

Section: Resultsmentioning

confidence: 99%

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Cardiac volume overload and pulmonary hypertension in long‐term follow‐up of patients with a transjugular intrahepatic portosystemic shunt

Wannhoff

Hippchen

Weiss

et al. 2016

Aliment Pharmacol Ther

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Section: Discussionsupporting

confidence: 89%

Section: Resultsmentioning

confidence: 98%

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Cardiac volume overload and pulmonary hypertension in long‐term follow‐up of patients with a transjugular intrahepatic portosystemic shunt

Wannhoff

Hippchen

Weiss

et al. 2016

Aliment Pharmacol Ther

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“…The main concern is that TIPSS may unmask latent diastolic dysfunction in patients with cirrhosis, as a result of the redirection of theportal circulation into the systemic circulation . The reported incidence of diastolic dysfunction pre‐TIPSS ranges from 30% to 56% and in keeping with this we observed a frequency of 33%. No global or individual parameter of cardiac structural or functional abnormality predicted 30‐day and overall‐transplant free survival in our cohort.…”

Section: Discussionsupporting

confidence: 84%

“…The insertion of TIPSS is therefore particularly pertinent in these patients, as it is recognised that by shunting a significant volume of the portal circulation to the central circulation, the cardiac output and right atrial pressures increase by 50% and 100%, respectively. Whilst some argue that cardiac (in particular diastolic) dysfunction predicts worse outcomes after TIPSS, others are more sceptical as overt cardiac failure is very rarely reported . There remains a paucity of data from routine clinical practice regarding the utility of echocardiography in the pre‐assessment of TIPSS.…”

Section: Introductionmentioning

confidence: 99%

Diastolic dysfunction on echocardiography does not predict survival after transjugular intrahepatic portosystemic stent‐shunt in patients with cirrhosis

Armstrong

Gohar

Dhaliwal

et al. 2019

Aliment Pharmacol Ther

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Background: Cardiac dysfunction is frequently observed in patients with cirrhosis. There remains a paucity of data from routine clinical practice regarding the role of echocardiography in the pre-assessment of transjugular intrahepatic portosystemic stent-shunt. Aim:Our study aimed to investigate if echocardiography parameters predict outcomes after transjugular intrahepatic portosystemic stent-shunt insertion in cirrhosis. Methods: Patients who underwent echocardiography and transjugular intrahepatic portosystemic stent-shunt insertion at the liver unit (Birmingham, UK) between 1999 and 2016 were included. All echocardiography measures (including left ventricle ejection fraction; early maximal ventricular filling/late filling velocity ratio, diastolic dysfunction as per British Society of Echocardiography guidelines) were independently reviewed by a cardiologist. Predictors of 30-day and overall transplant free-survival were assessed. Results: One Hundred and Seventeen patients with cirrhosis (median age 56 years; 54% alcohol; Child-Pugh B/C 71/14.5%; Model For End-Stage Liver Disease 12) underwent transjugular intrahepatic portosystemic stent-shunt for ascites (n = 78) and variceal haemorrhage (n = 39). Thirty-day and overall transplant-free survival was 90% (n = 105) and 31% (n = 36), respectively, over a median 663 (IQR 385-2368) days follow-up. Model for End-Stage Liver Disease (P < 0.001) and Child-Pugh Score (P = 0.002) significantly predicted 30-day and overall transplant-free survival. Model for End-Stage Liver Disease ≥15 implied three-fold risk of death. Six per cent (n = 7) of patients pre-transjugular intrahepatic portosystemic stent-shunt had a history of ischaemic heart disease and 34% (n = 40) had 1 or more cardiovascular disease risk factors. Fifty per cent (n = 59) had an abnormal echocardiogram and 33% (n = 39) had grade 1-3 diastolic dysfunction. On univariate analysis none of the echocardiography measures pre-intervention were related to 30-day or overall transplant-free survival post-transjugular intrahepatic portosystemic stent-shunt. Conclusions: Ventricular, in particular diastolic dysfunction in patients with cirrhosis does not predict survival after transjugular intrahepatic portosystemic stent-shunt insertion. Model for End-Stage Liver Disease and Child-Pugh scores remain the best predictors of survival. Further prospective study is required to clarify the role of routine echocardiography prior to transjugular intrahepatic portosystemic stentshunt insertion.

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Diastolic dysfunction is associated with cardiac decompensation after transjugular intrahepatic portosystemic shunt in patients with liver cirrhosis

Schneider,

Berliner,

Stockhoff

et al. 2023

UEG Journal

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Background and AimsAbout 20% of patients develop cardiac decompensation within the first year after transjugular intrahepatic portosystemic shunt (TIPS) insertion. However, risk factors for cardiac decompensation remain poorly defined. We aimed to evaluate predictors of cardiac decompensation after TIPS insertion in a large, well‐defined cohort of patients with liver cirrhosis.Methods234 cirrhotic patients who received a TIPS at Hannover Medical School were retrospectively followed up for one year to assess the incidence of cardiac decompensation. Echocardiographic parameters and established diagnostic criteria for cardiac impairment (e.g. by the American Society of Echocardiography/ European Association of Cardiovascular Imaging (ASE/EACVI)) were investigated for an association with cardiac decompensation in a competing risk analysis. Survival was analyzed using a multivariable cox regression analysis adjusting for Freiburg index of post‐TIPS survival.ResultsPredominant TIPS indication was ascites (83%). Median age was 59 years, median MELD‐score 12% and 58% were male. Overall, 41 patients (18%) developed cardiac decompensation within one year after TIPS insertion. Diastolic dysfunction according to the ASE/EACVI was diagnosed in 26% of patients at baseline and was linked to a significantly higher risk for cardiac decompensation (p = 0.025) after TIPS. When investigating individual echocardiographic baseline parameters, only pathological E/A (<0.8 or >2) was identified as a risk factor for cardiac decompensation (p = 0.015). Mortality and liver transplantation (n = 50) were significantly higher among patients who developed cardiac decompensation (HR = 5.29, p < 0.001) as well as in patients with a pathological E/A (HR = 2.34, p = 0.006). Cardiac high‐risk status (44% of patients) was strongly linked to cardiac decompensation (HR = 2.93, p = 0.002) and mortality (HR = 2.24, p = 0.012).ConclusionCardiac decompensation after TIPS is a frequent and important complication and is associated with reduced survival. American Society of Echocardiography/EACVI criteria and E/A seem to be the best parameters to predict the cardiac risk in cirrhotic patients undergoing TIPS insertion.

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Transjugular intrahepatic portosystemic shunt is associated with significant changes in mitral inflow parameters

Cited by 13 publications

References 23 publications

Cardiac volume overload and pulmonary hypertension in long‐term follow‐up of patients with a transjugular intrahepatic portosystemic shunt

Cardiac volume overload and pulmonary hypertension in long‐term follow‐up of patients with a transjugular intrahepatic portosystemic shunt

Diastolic dysfunction on echocardiography does not predict survival after transjugular intrahepatic portosystemic stent‐shunt in patients with cirrhosis

Diastolic dysfunction is associated with cardiac decompensation after transjugular intrahepatic portosystemic shunt in patients with liver cirrhosis

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