Humoral and cardiac effects of TIPS in cirrhotic patients with different "effective" blood volume

Salerno, Francesco; Cazzaniga, M.; Pagnozzi, Giovanni; Cirello, Ilaria; Nicolini, Antonio; Meregaglia, D; Burdick, L.

doi:10.1016/j.hep.2003.09.030

Cited by 29 publications

(21 citation statements)

References 49 publications

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“…Patients with advanced cirrhosis and portal hypertension can develop cardiomyopathy with left ventricular diastolic dysfunction [21] , hyperdynamic state, volume overload, and less commonly portopulmonary hypertension; these conditions can be aggravated with the insertion of TIPS [14,17,[22][23][24] . The placement of TIPS rapidly increases the RV preload and afterload, which can lead to overt heart failure, pulmonary hypertension and death [11,14,16,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] . RA pressure obtained before TIPS could be of value in clinical practice; physicians may elect to abort a TIPS procedure based on this hemodynamic parameter.…”

Section: Discussionmentioning

confidence: 99%

Predictors of mortality after transjugular portosystemic shunt

Ascha

Abuqayyas

Hanouneh

et al. 2016

WJH

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AIM:To investigate if echocardiographic and hemodynamic determinations obtained at the time of transjugular intrahepatic portosystemic shunt (TIPS) can provide prognostic information that will enhance risk Predictors of mortality after transjugular portosystemic shunt Retrospective Study ORIGINAL ARTICLEstratification of patients. METHODS:We reviewed medical records of 467 patients who underwent TIPS between July 2003 and December 2011 at our institution. We recorded information regarding patient demographics, underlying liver disease, indication for TIPS, baseline laboratory values, hemodynamic determinations at the time of TIPS, and echocardiographic measurements both before and after TIPS. We recorded patient comorbidities that may affect hemodynamic and echocardiographic determinations. We also calculated Model for Endstage Liver Disease (MELD) score and Child Turcotte Pugh (CTP) class. The following pre-and post-TIPS echocardiographic determinations were recorded: Left ventricular ejection fraction, right ventricular (RV) systolic pressure, subjective RV dilation, and subjective RV function. We recorded the following hemodynamic measurements: Right atrial (RA) pressure before and after TIPS, inferior vena cava pressure before and after TIPS, free hepatic vein pressure, portal vein pressure before and after TIPS, and hepatic venous pressure gradient (HVPG). RESULTS:We reviewed 418 patients with portal hypertension undergoing TIPS. RA pressure increased by a mean ± SD of 4.8 ± 3.9 mmHg (P < 0.001), HVPG decreased by 6.8 ± 3.5 mmHg (P < 0.001). In multivariate linear regression analysis, a higher MELD score, lower platelet count, splenectomy and a higher portal vein pressure were independent predictors of higher RA pressure (R = 0.55). Three variables predicted 3-mo mortality after TIPS in a multivariate analysis: Age, MELD score, and CTP grade C. Change in the RA pressure after TIPS predicted long-term mortality (per 1 mmHg change, HR = 1.03, 95%CI: 1.01-1.06, P < 0.012). CONCLUSION:RA pressure increased immediately after TIPS particularly in patients with worse liver function, portal hypertension, emergent TIPS placement and history of splenectomy. The increase in RA pressure after TIPS was associated with increased mortality. Age, splenectomy, MELD score and CTP grade were independent predictors of long-term mortality after TIPS. Core tip: Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure accompanied by morbidity and mortality. We hypothesize that echocardiographic and hemodynamic determinations obtained at the time of TIPS can provide prognostic information that will enhance risk stratification of patients. We measured echocardiographic and hemodynamic variables before and immediately after the TIPS procedure in a large cohort of patients at our institution. Our findings corroborate previous literature stating that right atrial pressure increased after TIPS. Our study demonstrates several predictors of long-term mortality after TIPS, such as age, splenectomy, and Model for End-s...

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Section: Discussionmentioning

confidence: 99%

Predictors of mortality after transjugular portosystemic shunt

Ascha

Abuqayyas

Hanouneh

et al. 2016

WJH

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“…In our population, there was a trend towards more astma/COPD cases among participants with an E/A ratio of under 0.75. Liver failure is also known to cause intravascular hypovolaemia, and an inverted mitral inflow pattern has been shown to co-exist with liver cirrhosis [11,12]. Unfortunately, liver function was not measured in the present data.…”

Section: Discussionmentioning

confidence: 71%

“…Among populations of advanced age, the attenuation of the E/A ratio can be caused by many mechanisms not related to heart failure [11][12][13][14]. Elderly have often impaired ability to sense thirst [23], and chronic dehydration is common among the elderly, especially among cognitively impaired individuals [24].…”

Section: Discussionmentioning

confidence: 99%

“…In addition to dehydration, an inverted mitral inflow pattern has been reported to be linked to several non-cardiovascular conditions such as liver cirrhosis [11,12] and pulmonary hypertension International Journal of Cardiology 155 (2012) 70-74 [13,14]. These conditions often carry a poor prognosis and are known to be common also among elderly populations.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Inverted mitral inflow pattern in echocardiography among the elderly — A marker of non-cardiovascular mortality and cognitive dysfunction

Kerola

Nieminen

Sulkava

et al. 2012

International Journal of Cardiology

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“…38 However, E/A ratio have several limitations as it is strongly dependent on preload and often requires age correction. 39 A recent study by Ruiz del Arbol et al showed LVDD in 37/80 (46.2%) with Tissue Doppler Imaging (TDI) in cirrhotic patients. They also found LVDD occurs simultaneously with other changes in cardiac structure and function and is associated with an impairment of effective arterial blood volume.…”

Section: Discussionmentioning

confidence: 98%