Diastolic dysfunction is associated with poor survival in patients with cirrhosis with transjugular intrahepatic portosystemic shunt
- Massimo Cazzaniga1,
- Francesco Salerno1,
- Giovanni Pagnozzi2,
- Elena Dionigi1,
- Stefania Visentin1,
- Ilaria Cirello1,
- Daniele Meregaglia3,
- Antonio Nicolini3
- 1Department of Internal Medicine, IRCCS Policlinico San Donato, Università degli Studi, San Donato Milanese, Milano, Italy
- 2Emergency Department, Ospedale Maggiore Policlinico, Mangialli e Regina Elena, Fondazione IRCCS, Milano, Italy
- 3Unit of Vascular Radiology, Ospedale Maggiore Policlinico, Mangialli e Regina Elena, Fondazione IRCCS, Milano, Italy
- Correspondence to:
Professor F Salerno
Department of Internal Medicine, Policlinico San Donato, University of Milan, Via Morandi 30, 20097 San Donato Milanese, Milano, Italy;
- Accepted 26 September 2006
- Revised 14 September 2006
- Published Online First 29 November 2006
Background: Transjugular intrahepatic portosystemic shunt (TIPS) is a treatment for portal hypertension-related complications. Accurate prediction of the outcome of patients treated with TIPS is important, because some patients have very short survival. Diastolic dysfunction is frequently observed in patients with cirrhosis.
Aim: To investigate whether or not diastolic dysfunction can predict the outcome after TIPS.
Methods: Echocardiography with Doppler exploration was performed before and 28 days after TIPS insertion in 32 patients with cirrhosis. Several echocardiographic measures, including the early maximal ventricular filling velocity/late filling velocity (E/A) ratio as indicative of diastolic function, as well as laboratory, clinical and demographic variables were evaluated as predictors of survival.
Results: Univariate analysis revealed that the presence of diastolic dysfunction observed 28 days after TIPS (E/A ratio ⩽1) and baseline model of end-stage liver disease score were related to survival. Multivariate analysis identified diastolic dysfunction as an independent predictor of death (RR 8.9, 95% CI 1.9 to 41.5, p = 0.005). During the first year of follow–up, six out of 10 patients with an E/A ratio ⩽1 died, whereas all 22 patients with E/A ratio >1 survived.
Conclusions: Diastolic dysfunction estimated using E/A ratio is a promising predictor of death in patients with cirrhosis who are treated with TIPS.
- A, atrial maximal filling velocity
- ANP, atrial natriuretic peptide
- CO, cardiac output
- DT, deceleration time
- E, early maximal ventricular filling velocity
- LVEDV, left ventricular end diastolic volume
- LVESV, left ventricular end systolic volume
- MAP, mean arterial pressure
- MELD, model of end-stage liver disease
- PRA, plasma renin activity
- SV, stroke volume
- SVR, systemic vascular resistance
- TIPS, transjugular intrahepatic portosystemic shunt
Published First Online 27 November 2006
Competing interests: None.