Post-Transjugular Intrahepatic Portosystemic Shunt Right Atrial Pressure and Left Atrial Volume Index Predict Heart Failure and Mortality: Dual Center Experience

INTRODUCTION: Heart failure (HF) after transjugular intrahepatic portosystemic shunt (TIPS) placement affects up to 20% of patients. Understanding factors associated with post-TIPS HF is critical. Cirrhotic cardiomyopathy (CCM) is associated with adverse clinical outcomes. We aim to evaluate whether hemodynamic measurements and echocardiographic markers of CCM pre-TIPS and post-TIPS can predict post-TIPS HF and death. METHODS: We performed a retrospective study of cirrhotic patients who underwent TIPS between 2010 and 2015 at 2 centers. Patients with cardiomyopathies other than CCM were excluded. A multivariable-adjusted time-to-event analysis assessed associations of clinical, hemodynamic, and echocardiographic parameters with post-TIPS HF and death during 2 years of follow-up. A 180-day landmark analysis was used to assess the association of echocardiographic changes with outcomes. RESULTS: In total, 360 patients met study criteria. 32 developed HF post-TIPS (8.8%). Right atrial pressure measured intraprocedurally post-TIPS insertion was associated with increased risk of HF (adjusted HR 1.10 [1.04-1.17]), with a cutoff of 22 mm Hg associated with highest risk (multivariable HR 2.71 [1.22-6.02]). 92 patients died (25.5%). An increase in left atrial volume index within 180 days post-TIPS was associated with increased mortality (HR 1.08 [1.01-1.15]). Other echocardiographic CCM markers were not associated with HF or death. DISCUSSION: Increases in right atrial pressure and left atrial volume index post-TIPS, but not CCM status, predict post-TIPS HF and death, respectively. Surveillance echocardiography may play a role in identifying those at highest risk of decompensation post-TIPS. Further prospective study of CCM and its markers in relation with TIPS outcomes is warranted.