title: Humoral and cardiac effects of TIPS in cirrhotic patients with different "effective" blood volume.
abstract: The aim of this study was to evaluate the cardiac effects of transjugular intrahepatic portosystemic shunts (TIPS) in cirrhotic patients with different effective blood volume. Two-dimensional echocardiography was performed before and 7 and 28 days after TIPS insertion in 7 cirrhotic patients with PRA <4 ng/mL/h (group A, normal effective blood volume) and 15 with PRA >4 ng/mL/h (group B, reduced effective blood volume). Before TIPS, most cirrhotic patients showed diastolic dysfunction as indicated by reduced early maximal ventricular filling velocity (E)/late filling velocity (A) ratio. Patients of group B differed from patients of group A because of smaller left ventricular volumes and stroke volume, indicating central underfilling. After TIPS insertion, portal decompression was associated with a significant increase of cardiac output (CO) and a decrease of peripheral resistances. The most important changes were recorded in patients of group B, who showed a significant increase of both the end-diastolic left ventricular volumes and the E/A ratio and a significant decrease of PRA. In conclusion, these results show that the hemodynamic effects of TIPS differ according to the pre-TIPS effective blood volume. Furthermore, TIPS improves the diastolic cardiac function of cirrhotic patients with effective hypovolemia. This result is likely due to a TIPS-related improvement of the fullness of central blood volume.
authors.affiliation: Department of Internal Medicine, University of Milan, Italy. francesco.salerno@unimi.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Salerno
authors.forename: Massimo
authors.initials: M
authors.lastname: Cazzaniga
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pagnozzi
authors.forename: Ilaria
authors.initials: I
authors.lastname: Cirello
authors.forename: Antonio
authors.initials: A
authors.lastname: Nicolini
authors.forename: Daniele
authors.initials: D
authors.lastname: Meregaglia
authors.forename: Larry
authors.initials: L
authors.lastname: Burdick
mesh_terms: D000368:Aged; D001810:Blood Volume; D002302:Cardiac Output; D003971:Diastole; D015150:Echocardiography, Doppler; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D008103:Liver Cirrhosis / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D012083:Renin / Q000097:blood
chemical_list: D012083:Renin