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Diastolic dysfunction is associated with cardiac decompensation after transjugular intrahepatic portosystemic shunt in patients with liver cirrhosis
BACKGROUND AND AIMS: About 20% of patients develop cardiac decompensation within the first year after transjugular intrahepatic portosystemic shunt (TIPS) insertion. However, risk factors for cardiac decompensation remain poorly defined. We aimed to evaluate predictors of cardiac decompensation afte...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10637125/ https://www.ncbi.nlm.nih.gov/pubmed/37897707 http://dx.doi.org/10.1002/ueg2.12471 |
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author | Schneider, Hannah Berliner, Dominik Stockhoff, Lena Reincke, Marlene Mauz, Jim B. Meyer, Bernhard Bauersachs, Johann Wedemeyer, Heiner Wacker, Frank Bettinger, Dominik Hinrichs, Jan B. Maasoumy, Benjamin |
author_facet | Schneider, Hannah Berliner, Dominik Stockhoff, Lena Reincke, Marlene Mauz, Jim B. Meyer, Bernhard Bauersachs, Johann Wedemeyer, Heiner Wacker, Frank Bettinger, Dominik Hinrichs, Jan B. Maasoumy, Benjamin |
author_sort | Schneider, Hannah |
collection | PubMed |
description | BACKGROUND AND AIMS: About 20% of patients develop cardiac decompensation within the first year after transjugular intrahepatic portosystemic shunt (TIPS) insertion. However, risk factors for cardiac decompensation remain poorly defined. We aimed to evaluate predictors of cardiac decompensation after TIPS insertion in a large, well‐defined cohort of patients with liver cirrhosis. METHODS: 234 cirrhotic patients who received a TIPS at Hannover Medical School were retrospectively followed up for one year to assess the incidence of cardiac decompensation. Echocardiographic parameters and established diagnostic criteria for cardiac impairment (e.g. by the American Society of Echocardiography/ European Association of Cardiovascular Imaging (ASE/EACVI)) were investigated for an association with cardiac decompensation in a competing risk analysis. Survival was analyzed using a multivariable cox regression analysis adjusting for Freiburg index of post‐TIPS survival. RESULTS: Predominant TIPS indication was ascites (83%). Median age was 59 years, median MELD‐score 12% and 58% were male. Overall, 41 patients (18%) developed cardiac decompensation within one year after TIPS insertion. Diastolic dysfunction according to the ASE/EACVI was diagnosed in 26% of patients at baseline and was linked to a significantly higher risk for cardiac decompensation (p = 0.025) after TIPS. When investigating individual echocardiographic baseline parameters, only pathological E/A (<0.8 or >2) was identified as a risk factor for cardiac decompensation (p = 0.015). Mortality and liver transplantation (n = 50) were significantly higher among patients who developed cardiac decompensation (HR = 5.29, p < 0.001) as well as in patients with a pathological E/A (HR = 2.34, p = 0.006). Cardiac high‐risk status (44% of patients) was strongly linked to cardiac decompensation (HR = 2.93, p = 0.002) and mortality (HR = 2.24, p = 0.012). CONCLUSION: Cardiac decompensation after TIPS is a frequent and important complication and is associated with reduced survival. American Society of Echocardiography/EACVI criteria and E/A seem to be the best parameters to predict the cardiac risk in cirrhotic patients undergoing TIPS insertion. |
format | Online Article Text |
id | pubmed-10637125 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-106371252023-11-15 Diastolic dysfunction is associated with cardiac decompensation after transjugular intrahepatic portosystemic shunt in patients with liver cirrhosis Schneider, Hannah Berliner, Dominik Stockhoff, Lena Reincke, Marlene Mauz, Jim B. Meyer, Bernhard Bauersachs, Johann Wedemeyer, Heiner Wacker, Frank Bettinger, Dominik Hinrichs, Jan B. Maasoumy, Benjamin United European Gastroenterol J Hepatobiliary BACKGROUND AND AIMS: About 20% of patients develop cardiac decompensation within the first year after transjugular intrahepatic portosystemic shunt (TIPS) insertion. However, risk factors for cardiac decompensation remain poorly defined. We aimed to evaluate predictors of cardiac decompensation after TIPS insertion in a large, well‐defined cohort of patients with liver cirrhosis. METHODS: 234 cirrhotic patients who received a TIPS at Hannover Medical School were retrospectively followed up for one year to assess the incidence of cardiac decompensation. Echocardiographic parameters and established diagnostic criteria for cardiac impairment (e.g. by the American Society of Echocardiography/ European Association of Cardiovascular Imaging (ASE/EACVI)) were investigated for an association with cardiac decompensation in a competing risk analysis. Survival was analyzed using a multivariable cox regression analysis adjusting for Freiburg index of post‐TIPS survival. RESULTS: Predominant TIPS indication was ascites (83%). Median age was 59 years, median MELD‐score 12% and 58% were male. Overall, 41 patients (18%) developed cardiac decompensation within one year after TIPS insertion. Diastolic dysfunction according to the ASE/EACVI was diagnosed in 26% of patients at baseline and was linked to a significantly higher risk for cardiac decompensation (p = 0.025) after TIPS. When investigating individual echocardiographic baseline parameters, only pathological E/A (<0.8 or >2) was identified as a risk factor for cardiac decompensation (p = 0.015). Mortality and liver transplantation (n = 50) were significantly higher among patients who developed cardiac decompensation (HR = 5.29, p < 0.001) as well as in patients with a pathological E/A (HR = 2.34, p = 0.006). Cardiac high‐risk status (44% of patients) was strongly linked to cardiac decompensation (HR = 2.93, p = 0.002) and mortality (HR = 2.24, p = 0.012). CONCLUSION: Cardiac decompensation after TIPS is a frequent and important complication and is associated with reduced survival. American Society of Echocardiography/EACVI criteria and E/A seem to be the best parameters to predict the cardiac risk in cirrhotic patients undergoing TIPS insertion. John Wiley and Sons Inc. 2023-10-28 /pmc/articles/PMC10637125/ /pubmed/37897707 http://dx.doi.org/10.1002/ueg2.12471 Text en © 2023 The Authors. United European Gastroenterology Journal published by Wiley Periodicals LLC on behalf of United European Gastroenterology. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Hepatobiliary Schneider, Hannah Berliner, Dominik Stockhoff, Lena Reincke, Marlene Mauz, Jim B. Meyer, Bernhard Bauersachs, Johann Wedemeyer, Heiner Wacker, Frank Bettinger, Dominik Hinrichs, Jan B. Maasoumy, Benjamin Diastolic dysfunction is associated with cardiac decompensation after transjugular intrahepatic portosystemic shunt in patients with liver cirrhosis |
title | Diastolic dysfunction is associated with cardiac decompensation after transjugular intrahepatic portosystemic shunt in patients with liver cirrhosis |
title_full | Diastolic dysfunction is associated with cardiac decompensation after transjugular intrahepatic portosystemic shunt in patients with liver cirrhosis |
title_fullStr | Diastolic dysfunction is associated with cardiac decompensation after transjugular intrahepatic portosystemic shunt in patients with liver cirrhosis |
title_full_unstemmed | Diastolic dysfunction is associated with cardiac decompensation after transjugular intrahepatic portosystemic shunt in patients with liver cirrhosis |
title_short | Diastolic dysfunction is associated with cardiac decompensation after transjugular intrahepatic portosystemic shunt in patients with liver cirrhosis |
title_sort | diastolic dysfunction is associated with cardiac decompensation after transjugular intrahepatic portosystemic shunt in patients with liver cirrhosis |
topic | Hepatobiliary |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10637125/ https://www.ncbi.nlm.nih.gov/pubmed/37897707 http://dx.doi.org/10.1002/ueg2.12471 |
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