Cardiac volume overload and pulmonary hypertension in long-term follow-up of patients with a transjugular intrahepatic portosystemic shunt.
Aliment Pharmacol Ther
; 43(9): 955-65, 2016 May.
Article
in En
| MEDLINE
| ID: mdl-26919285
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.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Cardiac Volume
/
Portasystemic Shunt, Transjugular Intrahepatic
/
Hypertension, Pulmonary
/
Liver Cirrhosis
Type of study:
Observational_studies
/
Prognostic_studies
Limits:
Adult
/
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
Aliment Pharmacol Ther
Journal subject:
FARMACOLOGIA
/
GASTROENTEROLOGIA
/
TERAPIA POR MEDICAMENTOS
Year:
2016
Document type:
Article
Affiliation country:
Germany