title: Cardiac volume overload and pulmonary hypertension in long-term follow-up of patients with a transjugular intrahepatic portosystemic shunt.
abstract: BACKGROUND
  Transjugular intrahepatic portosystemic shunt (TIPSS) cause haemodynamic changes in patients with cirrhosis, yet little is known about long-term cardiopulmonary outcomes.
  
  
  OBJECTIVE
  To evaluate the long-term cardiopulmonary outcome after TIPSS.
  
  
  METHODS
  We evaluated cardiopulmonary parameters including echocardiography during long-term follow-up after TIPSS. Results at 1-5 years after TIPSS were compared to those of cirrhotic controls. Pulmonary hypertension (PH) diagnoses rates were included. Endothelin 1, thromboxane B2 and serotonin were measured.
  
  
  RESULTS
  We found significant differences 1-5 years after TIPSS compared to pre-implantation values: median left atrial diameter (LAD) increased from 37 mm [interquartile range (IQR): 33-43] to 40 mm (IQR: 37-47, P = 0.001), left ventricular end-diastolic diameter (LV-EDD) increased from 45 mm (range: 41-49) to 48 mm (IQR: 45-52, P < 0.001), pulmonary artery systolic pressure (PASP) increased from 25 mmHg (IQR: 22-33) to 30 mmHg (IQR: 25-36, P = 0.038). Comparing results 1-5 years post-implantation to the comparison cohort revealed significantly higher (P < 0.05) LAD, LV-EDD and PASP values in TIPSS patients. PH prevalence was higher in the shunt group (4.43%) compared to controls (0.91%, P = 0.150). Thromboxane B2 levels correlated with PASP in the TIPSS cohort (P = 0.033). There was no transhepatic gradient observed for the vasoactive substances analysed.
  
  
  CONCLUSIONS
  TIPSS placement is accompanied by long-term cardiovascular changes, including cardiac volume overload, and is associated with an increased rate of pulmonary hypertension. The need for regular cardiac follow-up after TIPSS requires further evaluation.
authors.affiliation: Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Wannhoff
authors.affiliation: Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Hippchen
authors.affiliation: Department of Internal Medicine III, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: C S
authors.initials: CS
authors.lastname: Weiss
authors.affiliation: Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Friedrich
authors.affiliation: Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Rupp
authors.affiliation: Department of Medicine II, Freiburg University Medical Center, University of Freiburg, Freiburg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Neumann-Haefelin
authors.affiliation: Department of Internal Medicine I, University Hospital Ulm, Ulm, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Dollinger
authors.affiliation: Department of Medicine II, Heidelberg University Hospital at Mannheim, Mannheim, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Antoni
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Stampfl
authors.affiliation: Department of General Visceral and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Schemmer
authors.affiliation: Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Stremmel
authors.affiliation: Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: K H
authors.initials: KH
authors.lastname: Weiss
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Radeleff
authors.affiliation: Department of Internal Medicine III, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: H A
authors.initials: HA
authors.lastname: Katus
authors.affiliation: Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: D N
authors.initials: DN
authors.lastname: Gotthardt
mesh_terms: D000328:Adult; D002306:Cardiac Volume / Q000502:physiology*; D019332:Endothelin-1 / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000503:physiopathology*; D008103:Liver Cirrhosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects* / Q000379:methods; D012701:Serotonin / Q000378:metabolism; D013929:Thromboxane B2 / Q000378:metabolism
chemical_list: D019332:Endothelin-1; D012701:Serotonin; D013929:Thromboxane B2