Interv Akut Kardiol. 2013;12(1):8-11

Hemodynamic and echocardiographic changes in patients with liver cirrhosis treated

Radek Pudil¹, Rudolf Praus¹, Petr Hůlek², Václav Šafka², Tomáš Fejfar², Martina Vašatová³, Jan Vojáček¹

¹ I. interní kardioangilogická klinika LF UK a FN, Hradec Králové

² II. interní gastroenterologická klinika LF UK a FN, Hradec Králové

³ Ústav klinické biochemie a diagnostiky LF UK a FN, Hadec Králové

with transjugular intrahepatic portosystemic shunt

Purpose: Liver cirrhosis is associated with hyperdynamic circulation which can result in heart failure. Transjugular intrahepatic portosystemic

shunt (TIPS) due to increase of cardiac output is a stressful stimulus for cardiovascular system. Therefore, new methods for early

detection of heart failure are needed. The aim of the study was to analyze the effect of TIPS procedure on hemodynamic.

Material and Methods: 55 patients (38 men and 17 women, 55.6 ± 8.9 years) with liver cirrhosis treated with TIPS were enrolled in the

study. Echocardiography was performed before, 24 hours, 7, 30 and 180 days after the procedure.

Results: Left ventricular end-diastolic diameter (LVEDD) was increasing [before: median 47 (interquartile range: 44.7–51.2) mm, day 7: 50

(46.5–51.3) mm, p < 0.05; day 30: 49.5 (46.7–55.2) mm, p < 0.01; day 180: 52.5 (48.3–55.2) mm, p < 0.01)]. We noticed increase in vena cava

inferior (VCI) diameter [before: 17 (15.5–19) mm, 24 h: 17 (15.5–19), p ns; day 7: 18 (16.3–19.4), p ns; day 30: 18.7 (16.5–19.8) mm, p < 0.05; day 180:

19 (18.2–20.5), p < 0.05]. Right ventricular (RV) diameter was increasing [before: 27 (25–29) mm, 24 h: 28 (26–30) mm, p ns; day 7: 29 (27.5–30)

mm, p < 0.05; day 30: 30 (27–31) mm, p < 0.05; day 180: 30 (27.5–31.2), p < 0.05]. Transmitral E wave significantly was increasing [before: 75,5

(60.5–87.3) cm/s, 24 h: 88 (74.3–109.7), p < 0.01; day 7: 89 (81.5–105) p < 0.01; 1 month: 94 (82.7–108.5) p < 0.01; 6 months: 91 (80.1–120.2) p

< 0.01]. The E/A ratio was increasing during the follow up (baseline: 0.88, 24 h after: 0.89, 1 week: 1.0, 30 days: 1.13, 6 month: 1.06 p < 0.01).

Conclusion: Hemodynamic changes following TIPS procedure can be monitored using echocardiography. Transmitral flow analysis can

serve as a useful tool for evaluating of diastolic function in these patients.

Keywords: liver cirrhosis, transjugular portosystemic shunt, hemodynamics, echocardiography

Published: February 21, 2013  Show citation