Diastolic dysfunction as predictive parameter for the development of post-TIPS cardiac decompensation

Heart failure (HF) as a consequence of Transjugular Intrahepatic Portosystemic Shunt (TIPS) placement is associated with high mortality. Currently, no parameters can predict heart failure post-TIPS. This study evaluates the value of clinical, biochemical, and echocardiographic parameters, including speckle tracking echocardiography (STE) and hemodynamic forces (HDF), to predict development of post-TIPS HF.

This monocentre, retrospective study included patients with liver cirrhosis undergoing TIPS-placement and available echocardiogram prior to procedure. Two-dimensional STE and HDF measurements were performed using dedicated software. Post-TIPS HF was defined as new clinical signs of cardiac congestion post-TIPS. A logistic regression was performed to assess clinical predictors.

Fifty-two patients were included of whom 23 (44 %) developed post-TIPS HF within six months post-TIPS (30[15;128]days). No association was observed between STE and HDF and HF development, except for a trend for lower left atrial reservoir strain (OR:0.937[0.864;1.017],p = 0.120) and higher diastolic hemodynamic work (OR:2.301[0.800;6.62],p = 0.122). Logistic regression showed that the H₂FPEF-score (OR:1.14[1.05;1.23],p > 0.01) is a predictor for HF-development post-TIPS.

The H₂FPEF-score is an independent predictor of HF development within 6 months post-TIPS. Further research is necessary to determine whether screening for diastolic dysfunction and HFpEF, using the H2FPEF-score, can help identify those TIPS candidates at increased risk of post-procedural HF.