The use of E/A ratio as a predictor of outcome in cirrhotic patients treated with transjugular intrahepatic portosystemic shunt.
OBJECTIVE
The clinical significance of diastolic dysfunction in cirrhosis, a feature of cirrhotic cardiomyopathy, is unclear. The aim of this study was to assess the utility of E/A ratio, an indicator of diastolic dysfunction, to predict ascites clearance and mortality after transjugular intrahepatic portosystemic stent shunt (TIPS) insertion.


METHODS
A total of 101 cirrhotic patients who received TIPS had pre-TIPS assessments of demographics, severity of liver dysfunction (Child-Pugh and Model for End-Stage Liver Disease (MELD) scores), renal function, hemodynamics, and cardiac function (two-dimensional echocardiography). An E/A ratio of < or =1 was used to indicate diastolic dysfunction. Patients were followed-up for a mean period of 24.6+/-2.4 months post TIPS.


RESULTS
A total of 41 patients with an E/A ratio of < or =1 (group A), and 60 patients with an E/A ratio of >1 (group B) were studied. Group A had significantly higher MELD scores (14.0+/-1.0 vs. 11.4+/-0.8; P=0.03), because of higher serum creatinine levels (107+/-5 vs. 86+/-6 micromol/l; P<0.01). There was no difference in pre-TIPS systemic hemodynamics, systolic function, or portal pressure between the two groups. After TIPS, more patients in group B had ascites clearance (log rank, P=0.038), and the same patients had a higher probability of survival (log rank, P=0.046). There were three post-TIPS cardiac deaths in group A only. A multivariate analysis showed that an E/A of ratio < or =1 was predictive of slow ascites clearance (hazard ratio=7.3, 95% confidence interval=1.3-40.7, P=0.021) and death after TIPS (hazard ratio=4.7, 95% confidence interval=1.1-20.2, P=0.035).


CONCLUSIONS
Diastolic dysfunction, indicated by reduced E/A ratio, is prevalent in advanced cirrhosis and is associated with reduced ascites clearance and increased mortality post TIPS, possibly related to worsening of hemodynamic dysfunction in the post-TIPS period.
Rabie
Rania Nancy
RN
The Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada.
Cazzaniga
Massimo
M
Salerno
Francesco
F
Wong
Florence
F
D004452:Echocardiography; D005260:Female; D006334:Heart Function Tests; D006439:Hemodynamics; D006801:Humans; D007677:Kidney Function Tests; D008103:Liver Cirrhosis / Q000150:complications* / Q000601:surgery*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology*