Humoral and Cardiac Effects of TIPS in Cirrhotic Patients with Different "Effective" Blood Volume

Francesco Salerno, Massimo Cazzaniga, Giovanni Pagnozzi, Ilaria Cirello, Antonio Nicolini, Daniele Meregaglia, Larry Burdick

Research output: Contribution to journalArticlepeer-review

Abstract

The aim of this study was to evaluate the cardiac effects of transjugular intrahepatic portosystemic shunts (TIPS) in cirrhotic patients with different effective blood volume. Two-dimensional echocardiography was performed before and 7 and 28 days after TIPS insertion in 7 cirrhotic patients with PRA <4 ng/mL/h (group A, normal effective blood volume) and 15 with PRA > 4 ng/mL/h (group B, reduced effective blood volume). Before TIPS, most cirrhotic patients showed diastolic dysfunction as indicated by reduced early maximal ventricular filling velocity (E)/late filling velocity (A) ratio. Patients of group B differed from patients of group A because of smaller left ventricular volumes and stroke volume, indicating central underfilling. After TIPS insertion, portal decompression was associated with a significant increase of cardiac output (CO) and a decrease of peripheral resistances. The most important changes were recorded in patients of group B, who showed a significant increase of both the end-diastolic left ventricular volumes and the E/A ratio and a significant decrease of PRA. In conclusion, these results show that the hemodynamic effects of TIPS differ according to the pre-TIPS effective blood volume. Furthermore, TIPS improves the diastolic cardiac function of cirrhotic patients with effective hypovolemia. This result is likely due to a TIPS-related improvement of the fullness of central blood volume.

Original languageEnglish
Pages (from-to)1370-1377
Number of pages8
JournalHepatology
Volume38
Issue number6
DOIs
Publication statusPublished - Dec 2003

ASJC Scopus subject areas

  • Hepatology

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