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Post-Transjugular Intrahepatic Portosystemic Shunt Right Atrial Pressure and Left Atrial Volume Index Predict Heart
John Laurenzano1, Previn Ganesan2, Claire Harrington2
1Division of Gastroenterology and Hepatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
The American Journal of Gastroenterology
|December 24, 2024
Summary
Post-transjugular intrahepatic portosystemic shunt (TIPS) heart failure (HF) is predicted by increased right atrial pressure. Left atrial volume index increases predict mortality after TIPS, not cirrhotic cardiomyopathy status.
Area of Science:
- Cardiology
- Hepatology
- Medical Devices
Background:
- Heart failure (HF) complicates up to 20% of transjugular intrahepatic portosystemic shunt (TIPS) procedures.
- Cirrhotic cardiomyopathy (CCM) is linked to poor outcomes in liver disease.
- Identifying predictors of post-TIPS HF and mortality is crucial for patient management.
Purpose of the Study:
- To determine if pre- and post-TIPS hemodynamic and echocardiographic markers predict HF and death.
- To evaluate the role of CCM markers in predicting outcomes after TIPS.
Main Methods:
- Retrospective analysis of 360 cirrhotic patients undergoing TIPS (2010-2015).
- Exclusion of patients with non-CCM cardiomyopathies.
- Multivariable and landmark analyses assessed predictors of HF and death over 2-year follow-up.
Main Results:
- Post-TIPS HF occurred in 8.8% of patients.
- Elevated right atrial pressure post-TIPS (cutoff 22 mm Hg) predicted HF (aHR 2.71).
- Increased left atrial volume index within 180 days predicted mortality (HR 1.08).
Conclusions:
- Right atrial pressure and left atrial volume index, not CCM status, predict post-TIPS HF and mortality, respectively.
- Surveillance echocardiography may identify high-risk patients.
- Prospective studies on CCM and TIPS outcomes are needed.
Keywords:
cirrhotic cardiomyopathyheart failureportal hypertensiontransjugular intrahepatic portosystemic shuntMore Related Videos
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