Z Gastroenterol 2019; 57(09): e285
DOI: 10.1055/s-0039-1695363
Leber und Galle
Pfortaderthrombosen und TIPS, Lebersonografie: Freitag, 04. Oktober 2019, 11:20 – 12:56, Studio Terrasse 2.2 B
Georg Thieme Verlag KG Stuttgart · New York

The prognostic value of left ventricular myocardial contractility on survival of patients with cirrhosis before and after TIPS insertion

P Nordmann
1   Uniklinik Bonn, MED I, Bonn, Deutschland
,
C Jansen
1   Uniklinik Bonn, MED I, Bonn, Deutschland
,
M Praktiknjo
1   Uniklinik Bonn, MED I, Bonn, Deutschland
,
J Lehmann
1   Uniklinik Bonn, MED I, Bonn, Deutschland
,
C Strassburg
1   Uniklinik Bonn, MED I, Bonn, Deutschland
,
D Thomas
2   Uniklinik Bonn, Radiologische Klinik, Bonn, Deutschland
,
G Nickenig
3   Uniklinik Bonn, MED II, Bonn, Deutschland
,
M Weber
3   Uniklinik Bonn, MED II, Bonn, Deutschland
,
E Stöhr
3   Uniklinik Bonn, MED II, Bonn, Deutschland
,
C Hammerstingl
3   Uniklinik Bonn, MED II, Bonn, Deutschland
,
C Meyer
2   Uniklinik Bonn, Radiologische Klinik, Bonn, Deutschland
,
J Trebicka
4   Uniklinik Frankfurt, Medizinische Klinik 1, Frankfurt, Deutschland
5   European Foundation for Study of Chronic Liver Failure, Barcelona, Spanien
6   Faculty of Health Sciences, University of Southern Denmark, Odense, Dänemark
› Author Affiliations
Further Information

Publication History

Publication Date:
13 August 2019 (online)

Also available at
 

Background:

Left ventricular global longitudinal strain (LV-GLS) has been shown to reflect the left cardiac contractility in cirrhosis better than other investigations and might bear prognostic value. The aim of this study was to investigate the role of classical parameters of left and right ventricular TTE data, as well as the evolution of myocardial contractility assessed by STE after TIPS placement as possible predictors of survival.

Methods:

In this study, 206 (126 males) patients with liver cirrhosis receiving TIPS were included. In all study patients conventional TTE was performed before and after TIPS placement to assess left and right ventricular volume, planar and functional parameters. Also, LV-GLS was measured by STE to assess left ventricular contractility as surrogate for myocardial dysfunction. Hemodynamic and clinical parameters were assessed before TIPS and during follow-up.

Results:

As expected, most conventional parameters of TTE showed a significant change after TIPS placement. ESV significantly decreased, wheras EDV, sPAP and all of right ventricular parameters (TAPSE, RVV, RVD, RAA) significantly increased. However, neither the absolute, nor the change of conventional cardiac parameters of TTE before and after TIPS insertion were associated with survival. This might be reasoned in carefull cardiac evaluation of patients before TIPS. In contrast, LV-GLS evolution after TIPS was not significant, but more than 20% increase presented an independent predictor of survival.

Conclusion:

These results strengthen our further published data, that LV-GLS assessed by STE before TIPS can act as a predictor of survival in patients with liver cirrhosis receiving TIPS. Moreover, this study demonstrates for the first time, that a myocardial contractility increase of more than 20% after TIPS insertion assessed by STE is an independent predictor of survival and may identify patients at risk and in need of closer postinterventional care.