B0517 - Beta-Blockers Protective of Decompensated Congestive Heart Failure (dCHF) in Patients With Cirrhosis After Transjugular Intrahepatic Shunt (TIPSS)

Monday, October 24, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

Minh Thu T. Nguyen, MD

University of Connecticut Health Center
Farmington, CT

Award: Presidential Poster Award

Minh Thu T. Nguyen, MD¹, Monica M. Patel, MD², Matthew S. Berger, MD², Elizabeth Pope-Collins, MD², M. Katherine Dokus, BS, MPH², John A. Martens, MS, MPH², Ashwani K. Sharma, MD², Bandar M. Al-Judaibi, MBBS²
¹University of Connecticut Health Center, Farmington, CT; ²University of Rochester Medical Center, Rochester, NY

Introduction: Transjugular intrahepatic portosystemic shunt (TIPSS) is indicated to control complications of portal hypertension. Several studies have shown that hypervolemic states, including peripheral edema and decompensated congestive heart failure (dCHF), are potential complications post-TIPSS. The present study aims to identify risk factors for post-TIPSS dCHF among patients with cirrhosis.

Methods: Data were retrospectively collected for consecutive TIPSS procedures at a tertiary care center from January 2009 to December 2019 in cirrhotic patients. Patient demographics, medications, and echocardiographic parameters were included as part of the baseline characteristics. The primary outcome of dCHF was reviewed up to 6 months post-procedure. Patients lost to follow-up, prior liver transplants, and failed TIPSS insertion were excluded. Patient characteristics were compared using Pearson’s chi-squared tests, student’s t-test, or Mann-Whitney U tests. Univariate and multivariate Cox proportional-hazard models were performed to identify independent predictors of volume overload.

Results: One hundred sixteen patients were included, of which 56.0% (65/116 patients) were found to have dCHF post-procedure. The incidence of dCHF was significantly higher in those with an elevated serum creatinine (1.36 vs. 1.05 mg/dL; p=0.006), ischemic heart disease (IHD) (15.4% vs. 3.92%; p=0.044), and chronic kidney disease (CKD) (47.7% vs. 23.5%; p=0.007), and significantly lower in those on beta-blocker therapy (27.7% vs. 52.9%; p=0.006). On multivariate analysis, IHD was associated with increased occurrence of dCHF [hazard ratio (HR): 2.43 (1.11-5.33), p=0.026] and beta-blocker therapy with decreased occurrence of dCHF [HR: 0.47 (0.26-0.84), p=0.011].

Discussion: Ischemic heart disease was a predictor of dCHF in post-TIPSS patients with cirrhosis. Interestingly, beta-blocker therapy was protective of volume overload. Further studies are needed to identify patients at risk for dCHF post-TIPSS and to validate the protective effect of beta-blockers in this setting.

Characteristic	HR (95% CI)	p-value
CKD	1.62 (0.96-2.74)	0.069
Beta-blocker usage	0.47 (0.26-0.84)	0.011
IHD	2.43 (1.11-5.33)	0.026
Age, mean + SD	1.03 (0.99-1.06)	0.139
MELD-Na, median (IQR)	1.04 (0.99-1.08)	0.061

Table: Table 1. Multivariate Cox Regression. Abbreviations: HR - hazard ratio, CI - confidence interval, CKD - chronic kidney disease, IHD - ischemic heart disease, SD - standard deviation, MELD-Na - Model for End Stage Disease-Sodium, IQR - interquartile range.

Disclosures:

Minh Thu Nguyen indicated no relevant financial relationships.

Monica Patel indicated no relevant financial relationships.

Matthew Berger indicated no relevant financial relationships.

Elizabeth Pope-Collins indicated no relevant financial relationships.

M. Katherine Dokus indicated no relevant financial relationships.

John Martens indicated no relevant financial relationships.

Ashwani Sharma indicated no relevant financial relationships.

Bandar Al-Judaibi indicated no relevant financial relationships.

Minh Thu T. Nguyen, MD¹, Monica M. Patel, MD², Matthew S. Berger, MD², Elizabeth Pope-Collins, MD², M. Katherine Dokus, BS, MPH², John A. Martens, MS, MPH², Ashwani K. Sharma, MD², Bandar M. Al-Judaibi, MBBS². B0517 - Beta-Blockers Protective of Decompensated Congestive Heart Failure (dCHF) in Patients With Cirrhosis After Transjugular Intrahepatic Shunt (TIPSS), ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.