B0517 - Beta-Blockers Protective of Decompensated Congestive Heart Failure (dCHF) in Patients With Cirrhosis After Transjugular Intrahepatic Shunt (TIPSS)
University of Connecticut Health Center Farmington, CT
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.
