Transjugular intrahepatic portosystemic shunt is associated with significant changes in mitral inflow parameters

Abstract

Introduction. Liver cirrhosis is associated with hyperdynamic circulation which can result in heart failure. Transjugular intrahepatic portosystemic shunt (TIPS) due to increase of cardiac output is a stressful stimulus for cardiovascular system. Therefore, new methods for early detection of heart failure are needed. Transmitral flow is a marker of diastolic dysfunction.Aim. To analyze short- and long-term effect of TIPS procedure on transmitral flow.Material and Methods. 55 patients (38 men and 17 women, 55.6 ± 8.9 years) with liver cirrhosis treated with TIPS were enrolled in the study. Echocardiography was performed before, 24 h, 7, 30 and 180 days after the procedure. During 6 month follow up 22 patients died.Results. Left ventricle end-diastolic diameter was increasing during the follow-up [baseline: 47 (44.7–51.2) mm, day 7: 50 (46.5–51.3) mm, p < 0.05; day 30: 49.5 (46.7–55.2) mm, p < 0.01; 6 months: 52.5 (48.3–55.2) mm, p < 0.01)]. The peak early filling velocity (E) was significantly increasing [before: 75.5 (60.5–87.3) cm/s, 24 h: 88 (74.3–109.7), p < 0.01; day 7: 89 (81.5–105) p < 0.01; 1 month: 94 (82.7–108.5) p < 0.01; 6 month: 91 (80.1–120.2) p < 0.01]. Peak late atrial filling velocity (A) significantly increased within 24 h after the procedure: 85.1 (76.2–99.5) vs. 91.2 (81.5–104.5) cm/s, p < 0.05. The E/A ratio was increasing during the follow up (baseline: 0.88, 24 h after: 0.89, 1 week: 1.0, 30 days: 1.13, 6 month: 1.06 p < 0.01).Conclusion. Hemodynamic changes following TIPS procedure can be monitored using echocardiography. Transmitral flow analysis can serve as a useful tool for evaluating of diastolic function in these patients.

Keywords

• Diastolic dysfunction
• Liver cirrhosis
• Doppler mitral flow
• Hemodynamics