title: Circulatory response to volume expansion and transjugular intrahepatic portosystemic shunt in refractory ascites: Relationship with diastolic dysfunction.
abstract: BACKGROUND
  Cirrhotic cardiomyopathy may lead to heart failure in stressful circumstances, such as after transjugular intrahepatic portosystemic shunt (TIPS) placement.
  
  
  OBJECTIVE
  To examine whether acute volume expansion predicts haemodynamic changes after TIPS and elicits signs of impending heart failure.
  
  
  METHODS
  We prospectively evaluated refractory ascites patients (group A) and compensated cirrhotics (group B), who underwent echocardiography, NT-proBNP measurement, and heart catheterization before and after volume load; group A repeated measurements after TIPS.
  
  
  RESULTS
  15 patients in group A (80% male; 54±12.4 years) and 8 in group B (100% male; 56±6.2 years) were enrolled. Echocardiography disclosed diastolic dysfunction in 30% and 12.5%, respectively. In group A, volume load and TIPS induced a significant increase in right atrial, mean pulmonary, capillary wedge pressure and cardiac index, and a decrease in systemic vascular resistance (respectively, 4.7±2.8 vs. 9.9±3.6 mmHg; 13.3±3.5 vs. 21.9±5.9 mmHg; 8.3±3.4 vs. 15.4±4.7 mmHg; 3.7±0.7 vs. 4.6±11 t/min/m2; 961±278 vs. 767±285 dynscm(-5); and 10.1±3.3 vs. 14.2±3.4 mmHg; 17.5±4 vs. 25.2±4.2 mmHg; 12.3±4 vs. 19.3±3.4 mmHg; 3.4±0.8 vs. 4.5±0.91l t/min/m2; 779±62 vs. 596±199 dynscm(-5), p<0.001 for all pairs). At 24h, cardiopulmonary pressures returned towards baseline.
  
  
  CONCLUSIONS
  Acute volume expansion predicted haemodynamic changes immediately after TIPS. All patients had adequate haemodynamic adaptation to TIPS; none developed signs of heart failure.
authors.affiliation: Hepatology Unit, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS - ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy. Electronic address: dfili@ismett.edu.
authors.forename: Daniela
authors.initials: D
authors.lastname: Filì
authors.affiliation: Cardiology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS - ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy.
authors.forename: Calogero
authors.initials: C
authors.lastname: Falletta
authors.affiliation: Department of Diagnostic and Therapeutic Services, IRCCS - ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Luca
authors.affiliation: Cardiology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS - ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy.
authors.forename: Cesar
authors.initials: C
authors.lastname: Hernandez Baravoglia
authors.affiliation: Cardiology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS - ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Clemenza
authors.affiliation: Radiology Service, Department of Diagnostic and Therapeutic Services, IRCCS - ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Miraglia
authors.affiliation: Cardiology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS - ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Scardulla
authors.affiliation: Department of Economic, Business and Statistical Sciences, University of Palermo, Palermo, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Tuzzolino
authors.affiliation: Hepatology Unit, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS - ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Vizzini
authors.affiliation: Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS - ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Gridelli
authors.affiliation: Liver Unit, Hospital Clínic, University of Barcelona, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.
authors.forename: Jaime
authors.initials: J
authors.lastname: Bosch
mesh_terms: D000328:Adult; D000368:Aged; D001201:Ascites / Q000601:surgery*; D006328:Cardiac Catheterization; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D054144:Heart Failure, Diastolic / Q000175:diagnosis*; D006439:Hemodynamics; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000379:methods*; D011446:Prospective Studies; D013030:Spain; D014655:Vascular Resistance
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Cirrhosis; Echocardiography; Heart failure; Right heart catheterization; Transjugular portosystemic shunt