St. Louis University School of Medicine St. Louis, MO, United States
Francis Gerald Wade, MD1, Debapria Das, MD2, Yixi Tu, MD1, Sierra Dickey, DO2, Julien Feghaly, MD, MPH3, Philip Mar, PharmD, MD2, Kamran Qureshi, MD1 1St. Louis University School of Medicine, St. Louis, MO; 2St. Louis University, St. Louis, MO; 3University of Florida, Jacksonville, Jacksonville, FL
Introduction: Creation of a transjugular intrahepatic portosystemic shunt (TIPS) leads to a large shift of blood flow from splanchnic to systemic circulation. This hemodynamic change can both unmask pre-existing cardiac dysfunction and lead to maladaptive changes in cardiac physiology. The purpose of this study is to identify changes in echocardiogram parameters post-TIPS.
Methods: We performed a retrospective chart review of 36 patients who underwent TIPS at our institution between 8/2012 and12/2019. Paired T-test was used for statistical analysis to compare echocardiogram parameters between the same patients pre and post-TIPS.
Results: Within one year of TIPS procedure, patients were noted to have significant changes from their pre-TIPS echocardiogram (Table 1). These changes included increased aortic valve velocity and gradient, left ventricular outflow tract velocity, left ventricular peak velocity as reflected by E wave measurement, left atrial volume, right ventricular outflow tract velocity, and left ventricular relative wall thickness.
Discussion: Patients exhibited increased blood flow through the right and left heart post-TIPS with increased left sided volume and structural heart changes based on our analysis. To our knowledge, this is the longest follow up study comparing pre-and post-TIPS echocardiogram parameters in cirrhotic patients. Our findings provided echocardiographic evidence for the underlying physiology of portal to systemic blood shunting post-TIPS resulting in increased cardiac volume and velocity leading to higher cardiac output. Future studies are needed to explore the clinical implications of having increased cardiac output post-TIPS and whether that manifests into higher risk of clinical heart failure. Additionally, whether there is potential reversibility of these cardiac changes with remodeling is another area that awaits further exploration.
Pre-TIPS
Post-TIPS
TIPS Gradient (mmHg) (p= 0.000, n=36)
17.69 ± 5.89
7.44 ± 2.31
E Wave (cm/s) (p=0.006, n=32)
88.18 ± 19.83
102.99 ± 24.23
Left Ventricular Relative Wall Thickness (p=0.022, n=7)
0.37 ± 0.8
0.50 ± 0.12
LVOT Peak Velocity (cm/s)(p=0.024, n=31)
121.52 ± 20.71
133.35 ± 29.30
LVOT Peak Gradient (mmHg) (p=0.029, n=30)
6.00 ± 2.20
7.21 ± 3.04
Left Atrial Volume (ml) (p=0.000, n=23)
61.85 ± 24.33
89.09 ± 27.21
Left Atrial Volume Index (ml/m²)(p= 0.007, n=21)
32.21 ± 9.65
41.29 ± 13.71
Right Atrial Area (cm²) (p=0.16, n=4)
12.15 ± 1.68
17.36 ± 2.32
Aortic Valve Peak Velocity (cm/s)(p=0.016, n=31)
166.50 ± 54.00
193.92 ± 64.44
Aortic Valve Peak Gradient (mmHg)(p=0.000, n=31)
10.82 ± 8.52
16.26 ± 12.50
Aortic Valve Mean Velocity (cm/s) (p=0.010, n=12)
108.55 ± 21.31
138.48 ± 28.14
Aortic Valve Mean Gradient (mmHg) (p=0.001, n=28)
6.40 ± 5.63
9.48 ± 7.63
Aortic Valve Velocity Time Integral (cm)(p=0.000, n=17)
32.03 ± 8.47
41.10 ± 9.12
Aortic Valve Area (cm²)(p=0.001, n=22)
2.91 ± 0.49
2.48 ± 0.52
RVOT Peak Velocity (cm/s)(p=0.017, n=15)
81.59 ± 19.44
103.90 ± 25.16
Table: Significant changes in echocardiogram parameters after transjugular intrahepatic portosystemic shunt (paired T-test, sig two tailed) TIPS: Transjugular intrahepatic portosystemic shunt; LVOT: left ventricular outflow tract; RVOT: right ventricular outflow tract
Disclosures: Francis Gerald Wade indicated no relevant financial relationships. Debapria Das indicated no relevant financial relationships. Yixi Tu indicated no relevant financial relationships. Sierra Dickey indicated no relevant financial relationships. Julien Feghaly indicated no relevant financial relationships. Philip Mar indicated no relevant financial relationships. Kamran Qureshi indicated no relevant financial relationships.
Francis Gerald Wade, MD1, Debapria Das, MD2, Yixi Tu, MD1, Sierra Dickey, DO2, Julien Feghaly, MD, MPH3, Philip Mar, PharmD, MD2, Kamran Qureshi, MD1. P1800 - Changes in Echocardiogram Parameters After Transjugular Intrahepatic Portosystemic Shunt Placement, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
