BACKGROUND: Transjugular intrahepatic portosystemic shunt (TIPS) is a treatment for portal hypertension-related complications. Accurate prediction of the outcome of patients treated with TIPS is important, because some patients have very short survival. Diastolic dysfunction is frequently observed in patients with cirrhosis. AIM: To investigate whether or not diastolic dysfunction can predict the outcome after TIPS. METHODS: Echocardiography with Doppler exploration was performed before and 28 days after TIPS insertion in 32 patients with cirrhosis. Several echocardiographic measures, including the early maximal ventricular filling velocity/late filling velocity (E/A) ratio as indicative of diastolic function, as well as laboratory, clinical and demographic variables were evaluated as predictors of survival. RESULTS: Univariate analysis revealed that the presence of diastolic dysfunction observed 28 days after TIPS (E/A ratio </=1) and baseline model of end-stage liver disease score were related to survival. Multivariate analysis identified diastolic dysfunction as an independent predictor of death (RR 8.9, 95% CI 1.9 to 41.5, p = 0.005). During the first year of follow-up, six out of 10 patients with an E/A ratio </=1 died, whereas all 22 patients with E/A ratio >1 survived. CONCLUSIONS: Diastolic dysfunction estimated using E/A ratio is a promising predictor of death in patients with cirrhosis who are treated with TIPS.
BACKGROUND: Transjugular intrahepatic portosystemic shunt (TIPS) is a treatment for portal hypertension-related complications. Accurate prediction of the outcome of patients treated with TIPS is important, because some patients have very short survival. Diastolic dysfunction is frequently observed in patients with cirrhosis. AIM: To investigate whether or not diastolic dysfunction can predict the outcome after TIPS. METHODS: Echocardiography with Doppler exploration was performed before and 28 days after TIPS insertion in 32 patients with cirrhosis. Several echocardiographic measures, including the early maximal ventricular filling velocity/late filling velocity (E/A) ratio as indicative of diastolic function, as well as laboratory, clinical and demographic variables were evaluated as predictors of survival. RESULTS: Univariate analysis revealed that the presence of diastolic dysfunction observed 28 days after TIPS (E/A ratio </=1) and baseline model of end-stage liver disease score were related to survival. Multivariate analysis identified diastolic dysfunction as an independent predictor of death (RR 8.9, 95% CI 1.9 to 41.5, p = 0.005). During the first year of follow-up, six out of 10 patients with an E/A ratio </=1 died, whereas all 22 patients with E/A ratio >1 survived. CONCLUSIONS:Diastolic dysfunction estimated using E/A ratio is a promising predictor of death in patients with cirrhosis who are treated with TIPS.
Authors: W L Henry; A DeMaria; R Gramiak; D L King; J A Kisslo; R L Popp; D J Sahn; N B Schiller; A Tajik; L E Teichholz; A E Weyman Journal: Circulation Date: 1980-08 Impact factor: 29.690
Authors: V Arroyo; P Ginès; A L Gerbes; F J Dudley; P Gentilini; G Laffi; T B Reynolds; H Ring-Larsen; J Schölmerich Journal: Hepatology Date: 1996-01 Impact factor: 17.425
Authors: Adnan Said; John Williams; Jeremy Holden; Patrick Remington; Ronald Gangnon; Alexandru Musat; Michael R Lucey Journal: J Hepatol Date: 2004-06 Impact factor: 25.083
Authors: Pierpaolo Pellicori; Concetta Torromeo; Angela Calicchia; Alessandra Ruffa; Martina Di Iorio; John G F Cleland; Manuela Merli Journal: Clin Res Cardiol Date: 2013-09-01 Impact factor: 5.460
Authors: Sachin Batra; Victor I Machicao; John S Bynon; Shivang Mehta; Rajasekhar Tanikella; Michael J Krowka; Steven Zacks; James Trotter; Kari E Roberts; Robert S Brown; Steven M Kawut; Michael B Fallon Journal: Liver Transpl Date: 2014-06 Impact factor: 5.799