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2013, Number 3

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Ann Hepatol 2013; 12 (3)

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

Pudil R, Praus R, Hulek P, Safka V, Fejfar T, Vasatova M, Jirkovsky V

Language: English
References: 24
Page: 464-470
PDF size: 106.36 Kb.


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 ‹ 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.


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