title: Transjugular intrahepatic portosystemic shunt is associated with significant changes in mitral inflow parameters.
abstract: BACKGROUND
  Liver cirrhosis is associated with hyperdynamic circulation which can result in heart failure. Transjugular intrahepatic portosystemic shunt (TIPS) due to increase of cardiac output is a stressful stimulus for cardiovascular system. Therefore, new methods for early detection of heart failure are needed. Transmitral flow is a marker of diastolic dysfunction.
  
  
  OBJECTIVE
  To analyze short- and long-term effect of TIPS procedure on transmitral flow.
  
  
  METHODS
  55 patients (38 men and 17 women, 55.6 ± 8.9 years) with liver cirrhosis treated with TIPS were enrolled in the study. Echocardiography was performed before, 24 h, 7, 30 and 180 days after the procedure. During 6 month follow up 22 patients died. Results. Left ventricle end-diastolic diameter was increasing during the follow-up [baseline: 47 (44.7-51.2) mm, day 7: 50 (46.5-51.3) mm, p < 0.05; day 30: 49.5 (46.7-55.2) mm, p < 0.01; 6 months: 52.5 (48.3-55.2) mm, p < 0.01)]. The peak early filling velocity (E) was significantly increasing [before: 75.5 (60.5-87.3) cm/s, 24 h: 88 (74.3-109.7), p < 0.01; day 7: 89 (81.5-105) p < 0.01; 1 month: 94 (82.7-108.5) p < 0.01; 6 month: 91 (80.1-120.2) p < 0.01]. Peak late atrial filling velocity (A) significantly increased within 24 h after the procedure: 85.1 (76.2-99.5) vs. 91.2 (81.5-104.5) cm/s, p < 0.05. The E/A ratio was increasing during the follow up (baseline: 0.88, 24 h after: 0.89, 1 week: 1.0, 30 days: 1.13, 6 month: 1.06 p < 0.01).
  
  
  CONCLUSIONS
  Hemodynamic changes following TIPS procedure can be monitored using echocardiography. Transmitral flow analysis can serve as a useful tool for evaluating of diastolic function in these patients.
authors.affiliation: Charles University Prague, Faculty of Medicine, 1st Department of Medicine, Hradec Kralove, Czech Republic. pudilradek@yahoo.com
authors.forename: Radek
authors.initials: R
authors.lastname: Pudil
authors.forename: Rudolf
authors.initials: R
authors.lastname: Praus
authors.forename: Petr
authors.initials: P
authors.lastname: Hulek
authors.forename: Vaclav
authors.initials: V
authors.lastname: Safka
authors.forename: Tomas
authors.initials: T
authors.lastname: Fejfar
authors.forename: Martina
authors.initials: M
authors.lastname: Vasatova
authors.forename: Vaclav
authors.initials: V
authors.lastname: Jirkovsky
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D018618:Echocardiography, Doppler, Color; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology*; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects* / Q000401:mortality; D011237:Predictive Value of Tests; D013318:Stroke Volume; D013997:Time Factors; D016277:Ventricular Function, Left