Cardiovascular magnetic resonance demonstrates structural cardiac changes following transjugular intrahepatic portosystemic shunt

Abstract

Transjugular intrahepatic portosystemic shunt (TIPS) reduces portal hypertension in patients with liver cirrhosis. The exact cardiac consequences of subsequent increase of central blood volume are unknown. Cardiovascular magnetic resonance (CMR) imaging is the method of choice for quantifying cardiac volumes and ventricular function. The aim of this study was to investigate effects of TIPS on the heart using CMR, laboratory, and imaging cardiac biomarkers. 34 consecutive patients with liver cirrhosis were evaluated for TIPS. Comprehensive CMR with native T1 mapping, transthoracic echocardiography, and laboratory biomarkers were assessed before and after TIPS insertion. Follow-up (FU) CMR was obtained in 16 patients (47%) 207 (170–245) days after TIPS. From baseline (BL) to FU, a significant increase of all indexed cardiac chamber volumes was observed (all P < 0.05). Left ventricular (LV) end-diastolic mass index increased significantly from 45 (38–51) to 65 (51–73) g/m2 (P = < 0.01). Biventricular systolic function, NT-proBNP, high-sensitive troponin T, and native T1 time did not differ significantly from BL to FU. No patient experienced cardiac decompensation following TIPS. In conclusion, in patients without clinically significant prior heart disease, increased cardiac preload after TIPS resulted in increased volumes of all cardiac chambers and eccentric LV hypertrophy, without leading to cardiac impairment during follow-up in this selected patient population.

Elective Transjugular Intrahepatic Portosystemic Shunt Using Viatorr Stent-Grafts: A Single-Center Experience from China

“…Liver cirrhosis may lead to portal hypertension (PH)-related complications, including variceal bleeding from esophageal and/or gastric varices, and refractory ascites (RA), which represent the major causes of hospital admission. Transjugular intrahepatic portosystemic shunt (TIPS) can reduce portal hypertension, and is thus a well-established therapy for recurrent variceal bleeding and RA in cirrhotic patients [ 1 ].…”

Correlation of Myocardial Native T1 and Left Ventricular Reverse Remodeling after Valvular Surgery

“…All cardiac examinations were conducted by a 1.5-T MR scanner (Achieva; Philips Medical Systems, Best, The Netherlands). CMR was performed using a standardized protocol including an electrocardiogram-gated, standard steady-state, free-precession cine MR sequence, acquired during breath holds in standard long-axis views (4-, 3-, and 2-chamber view) and short-axis slices covering the entire left ventricle [ 8 ]. Native T1 mapping was acquired using a 5 s (3 s) 3 s modified Look-Locker inversion-recovery (MOLLI) sequence on three short-axis sections (apical, middle, and basal).…”

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

“…32 However, the results of Armstrong Similarly, a recent German study with 34 TIPS patients was not able to document the occurrence of any cardiac decompensation that required urgent medical attention in previously healthy patients. 28 Nevertheless, indicators associated with diastolic dysfunction worsened during follow-up. 28 In another study including no patients with the previously docu- Since we were able to find a large number of cardiac decompensations during long term follow up in our cohort, which has previously often been underestimated, we were able to show the relevance of cardiac assessment prior to TIPS insertion.…”

“…28 Nevertheless, indicators associated with diastolic dysfunction worsened during follow-up. 28 In another study including no patients with the previously docu- Since we were able to find a large number of cardiac decompensations during long term follow up in our cohort, which has previously often been underestimated, we were able to show the relevance of cardiac assessment prior to TIPS insertion. Fortunately, this assessment has recently become part of the EASL clinical practice guidelines for the management of patients with decompensated cirrhosis with regard to TIPS evaluation.…”