Diastolic dysfunction is associated with poor survival in patients with cirrhosis with transjugular intrahepatic portosystemic shunt.
BACKGROUND
Transjugular intrahepatic portosystemic shunt (TIPS) is a treatment for portal hypertension-related complications. Accurate prediction of the outcome of patients treated with TIPS is important, because some patients have very short survival. Diastolic dysfunction is frequently observed in patients with cirrhosis.


OBJECTIVE
To investigate whether or not diastolic dysfunction can predict the outcome after TIPS.


METHODS
Echocardiography with Doppler exploration was performed before and 28 days after TIPS insertion in 32 patients with cirrhosis. Several echocardiographic measures, including the early maximal ventricular filling velocity/late filling velocity (E/A) ratio as indicative of diastolic function, as well as laboratory, clinical and demographic variables were evaluated as predictors of survival.


RESULTS
Univariate analysis revealed that the presence of diastolic dysfunction observed 28 days after TIPS (E/A ratio </=1) and baseline model of end-stage liver disease score were related to survival. Multivariate analysis identified diastolic dysfunction as an independent predictor of death (RR 8.9, 95% CI 1.9 to 41.5, p = 0.005). During the first year of follow-up, six out of 10 patients with an E/A ratio </=1 died, whereas all 22 patients with E/A ratio >1 survived.


CONCLUSIONS
Diastolic dysfunction estimated using E/A ratio is a promising predictor of death in patients with cirrhosis who are treated with TIPS.
Cazzaniga
Massimo
M
Department of Internal Medicine, IRCCS Policlinico San Donato, University of Milan, Via Morandi 30, 20097 San Donato Milanese, Milano, Italy.
Salerno
Francesco
F
Pagnozzi
Giovanni
G
Dionigi
Elena
E
Visentin
Stefania
S
Cirello
Ilaria
I
Meregaglia
Daniele
D
Nicolini
Antonio
A
D000328:Adult; D000368:Aged; D003971:Diastole; D015150:Echocardiography, Doppler; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011184:Postoperative Period; D011379:Prognosis; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology