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

Jansen, Christian; Trebicka, Jonel

doi:10.1111/apt.15221

Cited by 3 publications

(3 citation statements)

References 11 publications

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“…Data from this study confirm the higher frequency of LVDD in decompensated cirrhotics, particularly in patients with advanced hemodynamic changes, HRS and refractory ascites, in agreement with a recent systematic review [27]. However, LVDD is not an absolute contraindication to TIPS, particularly in grade 1 and normal systolic function, but requires particular attention and care, especially in subjects with more advanced grades [22,28]. In the setting of TIPS for refractory ascites, these observations support the use of a TDI assessment with a complete morphological evaluation for better select patients in regard to the risk of poor clinical response and cardiac decompensation.…”

Section: Discussionsupporting

confidence: 90%

“…For these reasons, the diastolic dysfunction should be evaluated by early diastolic peak velocity of mitral annulus (E′) measurement by TDI [12,16]. Previous studies showed a low clinical significance of cardiac abnormalities and a low impact of cardiac dysfunction on medium-term prognosis in patients with cirrhosis but small populations were analysed, LVDD severity was not evaluated and invasive haemodynamic studies were not performed [20][21][22]. In our study, NR to TIPS was associated not only with LVDD, but frequently with its advanced stages (grades 2-3) and with the presence of worse baseline indices, such as left atrial dilation and increase of LVEDV.…”

Section: Discussionmentioning

confidence: 99%

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Transjugular intrahepatic portosystemic shunt in refractory ascites: clinical impact of left ventricular diastolic dysfunction

Venon

Pumo

Imperatrice

et al. 2021

European Journal of Gastroenterology &Amp; Hepatology

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Background and aims Left ventricular diastolic dysfunction (LVDD) in cirrhotics are associated with circulatory dysfunction, hepatorenal syndrome (HRS) and heart failure in stressful conditions. Transjugular intrahepatic portosystemic shunt (TIPS) exacerbates the hyperdynamic circulation and challenges cardiac function. We evaluated the incidence and the impact of LVDD in cirrhotic candidates to TIPS for refractory ascites. Methods Among 135 patients who underwent TIPS for refractory ascites, 63 cases (child B/C 53/10, Na-model for end-stage liver disease 16.5 ± 0.9) who had 2D-transthoracic-echocardiography with tissue-Doppler-imaging pre-TIPS were retrospectively analysed (group A); in 23 cases cardiac and hormonal assessment before and after TIPS was available. 41 cirrhotics without refractory ascites treated by banding ligation for variceal re-bleeding were used as controls (group B). Results The prevalence of LVDD was higher in group A (59%; 22% with grade ≥2) as compared to group B (35%; 7% with grade ≥2) (P < 0.01 and P < 0.03). A lack of clinical response to TIPS occurred in 10 patients, all with LVDD (P < 0.03 vs. no LVDD) and in patients with grade ≥2 LVDD mostly (P < 0.02 vs. grade 1). Central venous pressure >20 mmHg after TIPS and left ventricular end-diastolic volume at basal were predictors of no response to TIPS (P = 0.01 and P = 0.004, respectively), which was an independent predictor of death. Elevated levels of NT-proBNP 3 days after TIPS were associated with advanced cardiac dysfunction (P = 0.005). Conclusion NT-proBNP and careful LVDD investigation are useful to better select patients and to predict clinical response and mortality after TIPS.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Transjugular intrahepatic portosystemic shunt in refractory ascites: clinical impact of left ventricular diastolic dysfunction

Venon

Pumo

Imperatrice

et al. 2021

European Journal of Gastroenterology &Amp; Hepatology

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“…Armstrong et al examined a large cohort of 117 patients but none of the echocardiography measures pre-intervention were related to 30-day or overall transplant-free survival after TIPS insertion. Hence, there are no reliable parameters in echocardiography to predict outcome and overall survival in these patients (11,12). In the present study, we found no correlation between TTE parameters before and after TIPS insertion with survival.…”

Section: Discussioncontrasting

confidence: 72%

Change of Left Ventricular Myocardial Contractility in Speckle Tracking Echocardiography After Transjugular Intrahepatic Portosystemic Shunt Predicts Survival

Jansen¹,

Nordmann²,

Cremonese³

et al. 2022

Front. Gastroenterol.

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BackgroundLeft ventricular global longitudinal strain (LV-GLS) has been shown to better reflect the left cardiac contractility in cirrhosis than other investigations and might bear prognostic value. The aim of this study was to investigate the evolution of myocardial contractility assessed by speckle tracking echocardiography (STE) after transjugular intrahepatic portosystemic shunt (TIPS) placement and its prognostic value in outcome.MethodsIn this study, 206 (126 males) patients with liver cirrhosis receiving TIPS were included. In all study patients, conventional transthoracic echocardiography (TTE) was performed before and in the first weeks after TIPS placement to assess left and right ventricular volume, planar and functional parameters. Also, LV-GLS was measured by STE to assess left ventricular contractility as surrogate for myocardial dysfunction. Hemodynamic and clinical parameters were assessed before TIPS and during follow-up.ResultsAs expected, most conventional parameters of TTE showed a significant change after TIPS placement. However, neither the absolute values, nor the changes of conventional cardiac parameters of TTE before and after TIPS insertion were associated with survival. By contrast, an increase in contractility of more than 20% using STE after TIPS was an independent predictor of mortality.ConclusionThese results demonstrate that an increase of left ventricular contractility of more than 20% after TIPS insertion is an independent predictor of survival and this may identify patients at risk and in need of closer follow-up care.

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Transjugular intrahepatic portosystemic shunt for patients with liver cirrhosis: survey evaluating indications, standardization of procedures and anticoagulation in 43 German hospitals

Steib

Zhang

et al. 2019

European Journal of Gastroenterology &Amp; Hepatology

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Objectives Transjugular intrahepatic portosystemic shunt (TIPS) insertion is an established treatment to lower portal pressure. There are no obligatory evidence-based recommendations addressing procedure and anticoagulation. Therefore, a survey was performed to establish current practice at different German hospitals. Methods A three-page survey was sent out via postal mail to 76 different hospitals addressing the topics indication, contraindication, follow-up and anticoagulation. Results Forty-three hospitals completed the survey: the median number of TIPS/year was 28.6 ± 23. Ascites and hydrothorax were announced as the main indications. Bilirubin levels above 5 mg/dl, hepatic encephalopathy and cardiac disease were considered as absolute contraindications in most hospitals, but age was not. The biggest variations were reported with regard to anticoagulation after TIPS procedure. Four hospitals never used any anticoagulation; most hospitals reported the use of low molecular weight heparins for a period of days up to 4 weeks. But also aspirin or clopidogrel was used after TIPS insertion in eight different hospitals. Additionally, the standards for follow-up after TIPS insertion were different in the hospitals. Conclusions There is no consensus how to handle indication, contraindications and anticoagulation after the TIPS procedure. A national and international consensus is warranted to improve the outcome of TIPS patients and reduce secondary complications. In addition to compare results and efficacy in the future standard operation procedures as proposed here need to be put in place.

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

Abstract: Linked ContentThis article is linked to Armstrong et al paper. To view this article, visit https://doi.org/10.1111/apt.15164.

Cited by 3 publications

References 11 publications

Transjugular intrahepatic portosystemic shunt in refractory ascites: clinical impact of left ventricular diastolic dysfunction

Transjugular intrahepatic portosystemic shunt in refractory ascites: clinical impact of left ventricular diastolic dysfunction

Change of Left Ventricular Myocardial Contractility in Speckle Tracking Echocardiography After Transjugular Intrahepatic Portosystemic Shunt Predicts Survival

Transjugular intrahepatic portosystemic shunt for patients with liver cirrhosis: survey evaluating indications, standardization of procedures and anticoagulation in 43 German hospitals

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