Right Ventricular Contractility Predicts Clearance of Ascites After Transjugular Intrahepatic Portosystemic Shunt

Implantation of transjugular intrahepatic portosystemic shunt (TIPS) is an important treatment in patients with decompensated cirrhosis. The impact of right ventricular dysfunction on clinical outcomes after TIPS still needs to be defined. The aim of this study was to assess whether echocardiographic measures of right ventricular (RV) function using right ventricular global longitudinal strain (RV-GLS) are predictive of post-TIPS outcome.

Patients who were treated with TIPS implantation and received echocardiographic assessment of right ventricular function, including RV-GLS at two tertiary centers in Germany were included. The primary endpoint was the development of TIPS-refractory ascites. Secondary endpoints included post-TIPS cardiac decompensation, acute-on-chronic liver failure (ACLF) and transplantation-free survival.

A total of 198 patients were included with a median RV-GLS of -20.9 [-24.6 - (-17.4)]%. There was no correlation between RV-GLS and left ventricular (LV)-GLS. Patients with RV-GLS > -19% (indicating reduced right ventricular contractility) had a significantly higher risk for TIPS-refractory ascites compared to those with RV-GLS ≤ -19% (sHR 1.09 [95% CI: 1.04-1.16]; p = 0.001) considering liver transplantation and death as competing events. RV-GLS was significantly associated with cardiac decompensation after TIPS (sHR 1.10 [95% CI: 1.02-1.17], p = 0.007). RV-GLS did not independently affect the development of ACLF, but predicted transplantation-free survival (HR 1.10 [1.05-1.16], p < 0.001 adjusted to the FIPS score).

RV strain is an important predictor of post-TIPS outcomes. Functional right heart assessment before TIPS may be a useful tool for risk stratification.

ClinicalTrials.gov identifier: Freiburg: NCT05782556; Bonn, NCT04393519.