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Measurement of the Hepatic Venous Pressure Gradient and Transjugular Liver Biopsy
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Relevance of the Diagnostic Criteria for Diastolic Dysfunction in Patients With Transjugular Intrahepatic

Elena Motto1,2, Chiara Becchetti1, Giovanni Perricone1

  • 1Hepatology and Gastroenterology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.

Liver International : Official Journal of the International Association for the Study of the Liver
|November 22, 2025
PubMed

Insights

Newer cirrhotic cardiomyopathy (CCM) criteria for diastolic dysfunction (DD) do not predict adverse outcomes after transjugular intrahepatic portosystemic shunt (TIPS) placement. Liver disease severity is the key factor for predicting patient survival post-TIPS.

Area of Science:

  • Cardiology
  • Hepatology
  • Medical Devices

Background:

  • Cirrhotic cardiomyopathy (CCM), especially diastolic dysfunction (DD), often presents silently until hemodynamic stress.
  • Transjugular intrahepatic portosystemic shunt (TIPS) can unmask DD due to altered hemodynamics.
  • The predictive value of current CCM criteria for DD in patients undergoing TIPS is unclear.

Purpose of the Study:

  • To evaluate the impact of TIPS on cardiac and liver outcomes.
  • To assess different CCM criteria for diagnosing DD.
  • To identify predictors of adverse events and survival post-TIPS.

Main Methods:

  • Retrospective study of 184 cirrhotic patients undergoing TIPS (2014-2022).
  • Collected demographic, clinical, echocardiographic, and hemodynamic data.
  • Assessed 6-month outcomes including major adverse cardiovascular events (MACE), liver transplant (LT), and death, using 2005 and 2019 DD criteria.

Main Results:

  • DD prevalence was 90% (2005 criteria) vs. 25% (2019 criteria).
  • Patients with DD (2019 criteria) were older and had higher NT-proBNP, but showed no increased MACE or LT/death rates.
  • Liver disease severity (MELD score, portal pressure gradient) independently predicted LT-free survival.

Conclusions:

  • Current DD criteria (2019) have limited predictive value for post-TIPS adverse events.
  • Liver disease severity is the primary predictor of outcomes after TIPS.
  • Focus on liver disease severity is crucial for patient selection and management.
Abstract

Keywords:
cirrhotic cardiomyopathydiastolic dysfunctionechocardiographyliver hemodynamicliver transplantationportal hypertension

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