Article Text

PTU-090 Echocardiography in patients with cirrhosis does not predict the clinical outcome after transjugular intrahepatic portosystemic stent-shunt (tipss)
  1. F Gohar,
  2. MJ Armstrong


Introduction TIPSS is widely used to treat refractory ascites and variceal haemorrhage. Cardiac dysfunction is frequently observed in patients with cirrhosis. However, there remains a paucity of data from routine clinical practice regarding the use of echocardiography in the pre-assessment of TIPSS.

Aim To investigate if echocardiography predicts outcomes post-TIPSS in patients with cirrhosis.

Method Patients who underwent echocardiography and TIPSS at the liver transplant centre (Birmingham, UK) between 1999–2016 were included. All echocardiography measures [left ventricle (LV) ejection fraction (EF); LV diastolic diameter (LVDD); LV systolic diameter (LVSD); early maximal ventricular filling velocity/late filling velocity (E/A) ratio, deceleration time (DT), diastolic dysfunction as per ASE/BSE guidelines; regional wall abnormality) were independently reviewed/graded by a senior cardiologist (RS). Clinical predictors of 30 day, 90 day and overall transplant free-survival were assessed.

Results 117 patients with cirrhosis (median age 56 years; 54% alcohol; CPB/C 71/14.5%) underwent TIPSS for ascites (n=78) and variceal haemorrhage (n=39). Median MELD and UKELD was 12 (IQR 9–17) and 53 (IQR 50–57), respectively. Median post-TIPSS portal pressure gradient was 8 (IQR 6–10) mmHg. Post-TIPSS complications (<90 days) include arterial puncture (n-1), stent thrombosis (n=4), de novo encephalopathy (n=16), cardiac failure (n=1) and fulminant liver failure (n=2).

30 day, 90 day and overall transplant-free survival was 90% (n=105), 80% (n=93), and 31% (n=36) over a median 663 (IQR 385–2368) days follow-up. MELD (p<0.001), UKELD (p<0.01) and CP Score (p<0.01) significantly predicted 30 day and overall transplant-free survival. A MELD >/=15 had an AUROC 0.855 (95% CI 0.74–0.98) for 30 day transplant free-survival.

6% (n=7) of patients pre-TIPSS had a history of IHD and 34% (n=40) had 1 or more CVD risk factors. 50% (n=59) had a normal echocardiography, 33% (n=39) had grade 1–3 LV diastolic dysfunction and 6% (n=7) had LVEF<55%. On univariate analysis none of the pre=TIPSS echocardiography measures, including LVEF% (p=0.41), LVDD (p=0.07), LVSD (p=0.98), pulmonary artery pressure (p=0.87), E/A (p=0.27), DT (p=0.57), regional wall abnormality (p=0.97) and grade 1–3 LV diastolic dysfunction (p=0.47), were related to survival post-TIPSS.

Conclusion Echocardiography in patients with cirrhosis does not predict post-TIPSS survival. MELD score remains the best predictor of early and late mortality post-TIPSS.

Disclosure of Interest None Declared

  • None

Statistics from

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.