Long-term cardiac remodeling after transjugular intrahepatic portosystemic shunt placement: a cardiac MRI study

To evaluate long-term cardiovascular effects following insertion of a transjugular intrahepatic portosystemic shunt (TIPS) in patients with cirrhosis-induced portal hypertension.

In this prospective intra-individual study from 11/2018 to 5/2022, patients underwent combined hepatic and cardiac MRI before and at 1 year after TIPS insertion. Cardiac MRI included volumetric and functional assessment, strain analysis, T1 mapping, T2 mapping, myocardial edema, and late gadolinium enhancement (LGE). Hepatic and splenic imaging included T1 mapping, T2 mapping, and MR elastography-based liver stiffness. Paired Student's t-tests and Wilcoxon tests were used for statistical analyses.

17 patients (mean age 57 ± 11 years; 8 males) were included. Biventricular ejection fractions remained preserved, and no patient developed overt cardiac decompensation. LV strain improved significantly at follow-up (e.g., global longitudinal strain: -20.9 ± 4.2% vs. -25.1 ± 3.4%, p = 0.003). Compared to baseline, atrial and ventricular volumes increased (e.g., LV end-diastolic volume index: 80.2 ± 18.8 mL/m² vs. 96.9 ± 20.9 mL/m², p ≤ 0.001). Cardiac index increased at follow-up (3.5 ± 0.7 vs. 4.2 ± 0.8 L/min/m², p < 0.001). While quantitative LGE remained unchanged at follow-up, T1 and T2 relaxation times significantly decreased (e.g., T1: 1004 ± 34 msec vs. 975 ± 29 msec, p ≤ 0.001). Moreover, lower hepatic and splenic mapping values and liver stiffness were observed, indicating a systemic effect of portal decompression.

One year after TIPS insertion, cardiac MRI revealed partial reverse cardiac remodeling along with improved subclinical systolic function and resolution of diffuse myocardial edema. These findings suggest long-term cardiac adaptation to hemodynamic changes induced by portal decompression.

Question How does cardiac MRI characterize long-term cardiac remodelingafter TIPS implantation beyond the predominantly studied short-term hemodynamic adaptation? Findings Compared with the pre-TIPS baseline, cardiac MRI showed increased cardiac volumes and myocardial mass, improved left ventricular strain, and reduced myocardial edema 1 year after TIPS. Clinical relevance Cardiac MRI revealed long-term cardiac remodeling 1 year after portal decompression using TIPS in liver cirrhosis, including adaptive eccentric hypertrophy, improved systolic function, and normalization of diffuse myocardial edema.