title: Right atrial pressure may impact early survival of patients undergoing transjugular intrahepatic portosystemic shunt creation.
abstract: OBJECTIVE
  To elucidate the impact of right atrial (RA) pressure on early mortality after transjugular intrahepatic portosystemic shunt (TIPS).
  
  
  METHODS
  In this single institution retrospective study, 125 patients (M:F = 75:50, mean age 55 years) who underwent TIPS with recorded intra-procedural RA pressures between 1999-2012 were studied. Demographic (age, gender), liver disease (Child-Pugh, Model for End Stage Liver Disease or MELD score), and procedure (indication, urgency, Stent type, portosystemic gradient or PSG reduction, baseline and post-TIPS RA pressure) data were identified, and the influence of these parameters on 30- and 90-day mortality was assessed using binary logistic regression.
  
  
  RESULTS
  TIPS were created for variceal hemorrhage (n = 55) and ascites (n = 70). Hemodynamic success rate was 99% (124/125) and mean PSG reduction was 13 mmHg. 30- and 90-day mortality rates were 18% (19/106) and 28% (29/106). Baseline and final RA pressure were significantly associated with 30- (12 vs. 15 mmHg, P = 0.021; 18 vs. 21 mmHg, P = 0.035) and 90-day (12 vs. 14 mmHg, P = 0.022; 18 vs. 20 mmHg, P = 0.024) survival on univariate analysis. Predictive usefulness of RA pressure was not confirmed in multivariate analyses. Area under receiver operator characteristic (AUROC) curve analysis revealed good pre- and post-TIPS RA pressure predictive capacity for 30- (0.779, 0.810) and 90-day (0.813, 0.788) mortality among variceal hemorrhage patients at 14.5 and 21.5 mm Hg thresholds.
  
  
  CONCLUSIONS
  Intra-procedural RA pressure may have predictive value for early post-TIPS mortality. Pre-procedure consideration and optimization of patient cardiac status may enhance candidate selection, risk stratification, and clinical outcomes, particularly in variceal hemorrhage patients.
authors.affiliation: University of Illinois Hospital and Health Sciences System, Department of Radiology. Chicago, IL, USA.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Parvinian
authors.affiliation: University of Illinois Hospital and Health Sciences System, Department of Radiology. Chicago, IL, USA.
authors.forename: James T
authors.initials: JT
authors.lastname: Bui
authors.affiliation: University of Illinois Hospital and Health Sciences System, Department of Radiology. Chicago, IL, USA.
authors.forename: M Grace
authors.initials: MG
authors.lastname: Knuttinen
authors.affiliation: University of Illinois Hospital and Health Sciences System, Department of Radiology. Chicago, IL, USA.
authors.forename: Jeet
authors.initials: J
authors.lastname: Minocha
authors.affiliation: University of Illinois Hospital and Health Sciences System, Department of Radiology. Chicago, IL, USA.
authors.forename: Ron C
authors.initials: RC
authors.lastname: Gaba
mesh_terms: D019540:Area Under Curve; D001201:Ascites / Q000209:etiology; D016280:Atrial Function, Right / Q000502:physiology*; D062185:Atrial Pressure / Q000502:physiology*; D015331:Cohort Studies; D058625:End Stage Liver Disease; D004932:Esophageal and Gastric Varices / Q000209:etiology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006331:Heart Diseases / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D008103:Liver Cirrhosis / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000379:methods* / Q000401:mortality; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D016896:Treatment Outcome