In this study, investigators from Milan, Italy, evaluated the cardiac effects of transjugular intrahepatic portosystemic shunts (TIPS) in cirrhotic patients with different effective blood volumes.
They performed a 2-dimensional echocardiography was performed before and after TIPS insertion.
|Before TIPS most cirrhotic patients showed diastolic dysfunction.|
The team evaluated 7 cirrhotic patients with normal effective blood volume (group A) and 15 patients with reduced effective blood volume (group B).
Before TIPS, the team determined that most cirrhotic patients showed diastolic dysfunction.
They found that patients in group B differed from those in group A, due to smaller left ventricular volumes and stroke volume, indicating central underfilling.
Following TIPS insertion, the investigators noted that portal decompression was associated with a significant increase in cardiac output, as well as a decrease in peripheral resistances.
The team observed the most important changes in group B. Patients showed a significant increase in end-diastolic left ventricular volumes and the E/A ratio, and a significant decrease in PRA.
Dr Francesco Salerno's team concluded, "These results show that the hemodynamic effects of TIPS differ according to the pre-TIPS effective blood volume".
"Furthermore, TIPS improves the diastolic cardiac function of cirrhotic patients with effective hypovolemia".
"This result is likely due to a TIPS-related improvement of the fullness of central blood volume".