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Pre-TIPS Diastolic Dysfunction as a Predictor of Post-TIPS Outcomes in Patients With Cirrhosis

Shoma Bommena1, Jason Patel2, Pooja Rangan3

  • 1Division of Gastroenterology and Hepatology, University of Arizona College of Medicine-Tucson, Banner University Medical Center, Tucson, Arizona, USA.

Liver International : Official Journal of the International Association for the Study of the Liver
|December 9, 2025
PubMed

Insights

The 2020 Cirrhotic Cardiomyopathy (CCM) diastolic dysfunction (DD) criteria identify patients at higher risk for post-TIPS complications. Unlike older criteria, the 2020 CCM DD definition predicts adverse outcomes like cardiovascular events and organ dysfunction.

Area of Science:

  • Cardiology
  • Hepatology
  • Gastroenterology

Background:

  • Diastolic dysfunction (DD) is common in patients with decompensated cirrhosis.
  • The clinical significance of DD, as defined by the 2020 Cirrhotic Cardiomyopathy (CCM) guidelines, after transjugular intrahepatic portosystemic shunt (TIPS) placement is not well understood.
  • Previous criteria for DD may not accurately reflect risk in this population.

Purpose of the Study:

  • To evaluate the association between the 2020 CCM DD criteria and post-TIPS outcomes.
  • To compare the predictive value of the 2020 CCM DD criteria versus the 2005 DD criteria for adverse events following TIPS.

Main Methods:

  • A multicenter retrospective study included 261 adult patients who underwent TIPS between 2018 and 2022.
  • Patients were assessed for 2020 CCM DD criteria (≥3 of: E/e' ≥15, septal e' <7 cm/s, TRV >2.8 m/s, LAVI >34 mL/m²) within 6 months prior to TIPS.
  • Logistic regression models were used to analyze associations with post-TIPS outcomes, comparing with 2005 DD criteria (DT >200 ms, IVRT >80 ms, E/A <1).

Main Results:

  • Only 6.9% of patients met the 2020 CCM DD criteria. These patients were older and had higher rates of hypertension and MASLD.
  • Meeting the 2020 CCM DD criteria was associated with significantly higher odds of cardiovascular events (aOR 6.7), renal dysfunction (aOR 3.7), and liver dysfunction (aOR 7.4).
  • The 2005 DD criteria (met by 75.8% of patients) showed no association with post-TIPS outcomes.

Conclusions:

  • Diastolic dysfunction, as defined by the 2020 CCM criteria, is a significant predictor of early post-TIPS complications.
  • The 2020 CCM DD criteria, unlike the 2005 criteria, effectively identify cirrhotic patients at increased risk for adverse events after TIPS.
  • Patients meeting 2020 CCM DD criteria may benefit from closer post-TIPS monitoring due to associations with older age, hypertension, MASLD, and beta-blocker use.
Abstract

Keywords:
cardiovascular eventscirrhotic cardiomyopathyportal hypertensionrenal dysfunction

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