Modifications of cardiac function in cirrhotic patients treated with transjugular intrahepatic portosystemic shunt (TIPS)

Merli, Manuela; Valeriano, Valentina; Funaro, Stefania; Attili, A.F.; Masini, Andrea; Efrati, C.; Castro, S. De; Riggio, Oliviero

doi:10.1111/j.1572-0241.2002.05438.x

Cited by 85 publications

(33 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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

View full text Add to dashboard Cite

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...

show abstract

Section: Discussionmentioning

confidence: 99%

Predictors of mortality after transjugular portosystemic shunt

Ascha

Abuqayyas

Hanouneh

et al. 2016

WJH

View full text Add to dashboard Cite

show abstract

“…18 Merli et al have shown a significantly increased cardiac workload and in some cases, abnormal responses, in patients after TIPS insertion. 19 In this issue, Ruiz-del-Arbol et al present novel data that suggests yet another significant complication of impaired ventricular function in cirrhosis. 20 They found that, among a cohort of patients with spontaneous bacterial peritonitis (SBP), those that developed acute renal failure (hepatorenal syndrome) showed significantly less cardiac reserve than those whose renal function remained unimpaired.…”

mentioning

confidence: 99%

Cardiac dysfunction in spontaneous bacterial peritonitis: A manifestation of cirrhotic cardiomyopathy?

Lee

2003

Hepatology

View full text Add to dashboard Cite

“…Various other authors also reported more or less similar findings. The highest prevalence was reported by Merli et al 20 (Table 9). We did not use stress echo in our study, which could have probably underestimated the actual prevalence of cardiac dysfunction.…”

Section: Discussionmentioning

confidence: 61%

Serum Pro – Brain Natriuretic Peptide (Pro - Bnp) in Patients With Cirrhosis : Relation to Cardiac Dysfunction and Severity of Disease

Bogadi¹,

Azmi²,

K³

et al. 2015

jemds

View full text Add to dashboard Cite

BACKGROUND AND AIMSSubclinical cardiac dysfunction is present in many patients with cirrhosis and is an important cause of morbidity and mortality post-transplant. We tried to study the prevalence of cardiac dysfunction in cirrhotics and assess the relationship between pro-BNP as a marker of cardiac dysfunction and the severity of cirrhosis. We also evaluated the clinical aspects of cirrhosis and their relation to cardiac dysfunction.

show abstract

Modifications of cardiac function in cirrhotic patients treated with transjugular intrahepatic portosystemic shunt (TIPS)

Abstract: Our study demonstrates that nonalcoholic cirrhotic patients, without cardiovascular pathologies, show transient modifications in cardiac dimension and function for 3-6 months after TIPS caused by the increased volume load shunted to the heart.

Cited by 85 publications

References 24 publications

Predictors of mortality after transjugular portosystemic shunt

Predictors of mortality after transjugular portosystemic shunt

Cardiac dysfunction in spontaneous bacterial peritonitis: A manifestation of cirrhotic cardiomyopathy?

Serum Pro – Brain Natriuretic Peptide (Pro - Bnp) in Patients With Cirrhosis : Relation to Cardiac Dysfunction and Severity of Disease

Contact Info

Product

Resources

About