Abstract

Background and Aims: TIPS is a treatment for portal hypertension-related complications. Accurate prediction of the outcome of patients treated with TIPS is important because the survival of some patients is very short. Diastolic dysfunction is frequently observed in patients with cirrhosis. Consequently, whether or not diastolic dysfunction can predict the outcome after TIPS is investigated in this study.

Methods: Echocardiography with Doppler exploration was performed before and 28 days after TIPS insertion in 32 cirrhotic patients. Several echocardiographic measures, including E/A (early maximal filling velocity/late filling velocity) 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 MELD score were related to survival. Multivariate analysis identified diastolic dysfunction as an independent predictor of death (RR 8.9; 95%CI 1.9-41.5; P=0.005). During the first year of follow up 6 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 cirrhotic patients with TIPS.