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

Max F G H M Venner1, Tom J G Gevers2, Fabienne Ploum3

  • 1Department of Cardiology, Maastricht University, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands; Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands.

International Journal of Cardiology
|April 4, 2025
PubMed
Summary

Heart failure (HF) after Transjugular Intrahepatic Portosystemic Shunt (TIPS) placement is a serious risk. The H2FPEF score effectively predicts HF development within six months post-TIPS, aiding in risk assessment for liver cirrhosis patients.

Keywords:
Diastolic dysfunctionHFpEFHemodynamic forcesStrain analysis

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Area of Science:

  • Cardiology
  • Hepatology
  • Medical Imaging

Background:

  • Transjugular Intrahepatic Portosystemic Shunt (TIPS) placement can lead to heart failure (HF) with high mortality.
  • Predictive parameters for post-TIPS HF are currently lacking.
  • This study aimed to identify predictors of post-TIPS HF using clinical, biochemical, and echocardiographic data.

Purpose of the Study:

  • To evaluate the predictive value of clinical, biochemical, and echocardiographic parameters, including speckle tracking echocardiography (STE) and hemodynamic forces (HDF), for post-TIPS HF development.
  • To identify reliable indicators for predicting heart failure following TIPS procedures.

Main Methods:

  • A retrospective, monocenter study included 52 patients with liver cirrhosis undergoing TIPS.
  • Pre-procedure echocardiograms were analyzed using 2D STE and HDF measurements.
  • Post-TIPS HF was defined by new clinical signs of cardiac congestion; logistic regression identified predictors.

Main Results:

  • Of 52 patients, 23 (44%) developed post-TIPS HF within six months.
  • No significant association was found between STE/HDF parameters and HF development.
  • The H2FPEF score emerged as a significant independent predictor of HF development post-TIPS.

Conclusions:

  • The H2FPEF score is a validated independent predictor of heart failure within six months after TIPS.
  • Further research should explore using the H2FPEF score for screening high-risk TIPS candidates for diastolic dysfunction and HFpEF.
  • This could help identify patients at increased risk of post-procedural HF.