Modifications of cardiac function in cirrhotic patients treated with transjugular intrahepatic portosystemic shunt (TIPS).
OBJECTIVE
The implantation of a transjugular intrahepatic portosystemic shunt (TIPS) has been shown to exacerbate the hyperdynamic circulation and might induce a significant cardiac overload. We investigated cardiac function before and 1, 3, 6, and 12 months after the TIPS procedure in cirrhotic patients.


METHODS
Eleven patients with nonalcoholic cirrhosis were evaluated. Cardiovascular parameters were assessed by two-dimensional Doppler echocardiography.


RESULTS
After TIPS, the left ventricular diastolic diameter increased from 26.5 +/- 1.8 mm (basal) to 30.0 +/- 2.8 mm (6 months) (p < 0.05), whereas the ejection fraction showed a slight increase (basal, 64.5 +/- 3.3; 6 months, 68.1 +/- 3.2). The left ventricular pre-ejection period and the isovolumetric relaxation time decreased transiently at 1 month (p < 0.05). An increased velocity in all of the components of pulmonary venous flow (systolic, diastolic, and atrial) documented the accelerated fluxes induced by the procedure. The estimated pulmonary systolic arterial pressure also increased at 1 month (29.5 +/- 1.4 vs 44.1 +/- 1.4 mm Hg, p < 0.05). All of these modifications reverted after 6 months.


CONCLUSIONS
Our study demonstrates that nonalcoholic cirrhotic patients, without cardiovascular pathologies, show transient modifications in cardiac dimension and function for 3-6 months after TIPS caused by the increased volume load shunted to the heart.
Merli
Manuela
M
Department of Clinical Medicine, University of Rome La Sapienza, Italy.
Valeriano
Valentina
V
Funaro
Stefania
S
Attili
Adolfo Francesco
AF
Masini
Andrea
A
Efrati
Cesare
C
De
Castro Stefano
CS
Riggio
Oliviero
O
D000368:Aged; D002318:Cardiovascular Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006334:Heart Function Tests; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000379:methods*; D011184:Postoperative Period; D011300:Preoperative Care; D011336:Probability; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors; D016896:Treatment Outcome