Key result
Baseline diastolic dysfunction linked to ~122% higher risk of cardiac decompensation after TIPS.
Why the study?
About 20% of patients develop cardiac decompensation within the first year after TIPS insertion, but risk factors remain poorly defined.
Does baseline diastolic dysfunction predict cardiac decompensation in patients with liver cirrhosis undergoing TIPS insertion?
Cohort (n=234)
Yes
Does baseline diastolic dysfunction predict cardiac decompensation in patients with liver cirrhosis undergoing TIPS insertion?
Hazard Ratio: 2.22 (95% CI 1.1–4.46)
p-value: p=0.025
Baseline diastolic dysfunction and pathological E/A ratio strongly predict the development of cardiac decompensation and mortality in cirrhotic patients undergoing TIPS insertion.
May inform pre-TIPS risk stratification in cirrhosis; leaves open whether cardiac optimization alters decompensation.
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.
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Rieland et al. (2023) conducted a cohort in Liver cirrhosis (n=234). Diastolic dysfunction (ASE/EACVI criteria) vs. Absence of diastolic dysfunction was evaluated on Cardiac decompensation within one year after TIPS insertion (HR 2.22, 95% CI 1.10-4.46, p=0.025). Baseline diastolic dysfunction according to ASE/EACVI criteria significantly increased the risk of cardiac decompensation within one year after TIPS insertion in patients with liver cirrhosis (HR 2.22).
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