A Wannhoff1, T Hippchen1, C S Weiss2, K Friedrich1, C Rupp1, C Neumann-Haefelin3, M Dollinger4, C Antoni5, U Stampfl6, P Schemmer7, W Stremmel1, K H Weiss1, B Radeleff6, H A Katus2, D N Gotthardt1. 1. Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany. 2. Department of Internal Medicine III, University Hospital Heidelberg, Heidelberg, Germany. 3. Department of Medicine II, Freiburg University Medical Center, University of Freiburg, Freiburg, Germany. 4. Department of Internal Medicine I, University Hospital Ulm, Ulm, Germany. 5. Department of Medicine II, Heidelberg University Hospital at Mannheim, Mannheim, Germany. 6. Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany. 7. Department of General Visceral and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany.
Abstract
BACKGROUND: Transjugular intrahepatic portosystemic shunt (TIPSS) cause haemodynamic changes in patients with cirrhosis, yet little is known about long-term cardiopulmonary outcomes. AIM: 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.
BACKGROUND: Transjugular intrahepatic portosystemic shunt (TIPSS) cause haemodynamic changes in patients with cirrhosis, yet little is known about long-term cardiopulmonary outcomes. AIM: 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: Faisal Khan; Ian Rowe; Bill Martin; Ellen Knox; Tracey Johnston; Charlie Elliot; Will Lester; Frederick Chen; Simon Olliff; Homoyon Mehrzad; Zergham Zia; Dhiraj Tripathi Journal: World J Hepatol Date: 2017-07-28
Authors: Dhiraj Tripathi; Adrian J Stanley; Peter C Hayes; Simon Travis; Matthew J Armstrong; Emmanuel A Tsochatzis; Ian A Rowe; Nicholas Roslund; Hamish Ireland; Mandy Lomax; Joanne A Leithead; Homoyon Mehrzad; Richard J Aspinall; Joanne McDonagh; David Patch Journal: Gut Date: 2020-02-29 Impact factor: 23.059