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

Wannhoff, Andreas; Hippchen, Theresa; Weiss, Claus; Friedrich, Kilian; Rupp, Christian; Neumann‐Haefelin, Christoph; Dollinger, Matthias; Antoni, Christoph; Stampfl, Ulrike; Schemmer, Peter; Stremmel, Wolfgang; Weiss, Karl Heinz; Radeleff, Boris; Katus, Hugo A.; Gotthardt, Daniel

doi:10.1111/apt.13569

Cited by 45 publications

(40 citation statements)

References 31 publications

(46 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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 role of echocardiography in all patients undergoing TIPSS remains under considerable debate, especially as some arguethat overt cardiac failure is very rarely reported in patients with cirrhosis . Indeed, only 1.7% (2/117) of our study cohort had early‐onset (<90 days) cardiac death attributed to TIPSS insertion, both of which occurred prior to the 2005 international guidelines in TIPSS .…”

Section: Discussionmentioning

confidence: 89%

“…Furthermore, in 2016 Wannhoff et al performed a case‐control study of 55 patients with cirrhosis (mean MELD 12) undergoing TIPSS with echocardiography and right heart catheterisation pre‐ and post‐insertion. They reported no differences in transplant‐free survival post‐TIPSS between patients with and without diastolic dysfunction, and interestingly found no significant changes in either diastolic or systolic function post‐TIPSS . The latter was supported by a small (n = 15) prospective study from Italy, in which they observed no cardiac deaths and no changes from baseline in parameters of diastolic dysfunction (E/A ratio, DT) 28 days post‐TIPSS …”

Section: Discussionmentioning

confidence: 89%

“…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%

See 3 more Smart Citations

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

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

View full text Add to dashboard Cite

show abstract

“…The retrospective study by Wannhoff et al . investigated the effects of TIPSS on cardiac function and systolic pulmonary arterial pressures using echocardiography. The findings were compared to a matched cohort of 110 patients waiting for liver transplantation.…”

mentioning

confidence: 99%

Editorial: cardiac volume overload and pulmonary hypertension in long‐term follow‐up of TIPSS patients

Rössle

Schupp

Köhler

et al. 2016

Aliment Pharmacol Ther

View full text Add to dashboard Cite

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

Jansen¹,

Schröder²,

Schueler³

et al. 2019

Hepatol Commun

View full text Add to dashboard Cite

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.

show abstract

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

Abstract: TIPSS placement is accompanied by long-term cardiovascular changes, including cardiac volume overload, and is associated with an increased rate of pulmonary hypertension. The need for regular cardiac follow-up after TIPSS requires further evaluation.

Cited by 45 publications

References 31 publications

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

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

Editorial: cardiac volume overload and pulmonary hypertension in long‐term follow‐up of TIPSS patients

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

Contact Info

Product

Resources

About