Cardiac volume overload and pulmonary hypertension in long-term follow-up of patients with a transjugular intrahepatic portosystemic shunt

Summary

Background

Transjugular intrahepatic portosystemic shunt (TIPSS) cause haemodynamic changes in patients with cirrhosis, yet little is known about long-term cardiopulmonary outcomes.

Aim

To evaluated 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.

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