Unveiling the impact of cirrhotic cardiomyopathy on portal hemodynamics and survival after transjugular intrahepatic portosystemic shunt: a prospective study

Abstract Background: The placement of Transjugular intrahepatic portosystemic shunt (TIPS) results in a sudden increase in central circulating blood volume, which requires proper regulation of the cardiovascular system. The presence of diastolic dysfunctional cirrhotic cardiomyopathy (CCM) indicates myocardial dysfunction which may lead to adverse outcomes in patients treated TIPS. The aim of our study was to investigate the impact of diastolic dysfunction on TIPS. Method: A consecutive case series of patients with cirrhosis aged 18-65 years who underwent TIPS were prospectively studied. Results: From June 2020 to January 2022, 82 patients were included. According to the Cirrhotic Cardiomyopathy Consortium (CCC), 48.8% had no LVDD, 20.7% had grade 1, 14.6% had grade 2, and 15.9% were indeterminate. The incidence of diastolic dysfunctional CCM is 14.6% in our study. The results indicate that RAP increased after TIPS and returned to baseline after 48 hours in patients with CCM (4.63±2.46 VS 6.42±2.75 p=0.076). In contrast, patients without CCM had lower RAP than baseline after 48 hours (4.63±3.05 VS 5.64±3.19, p=0.001).And no statistical significance was observed in the comparison of various pressures at different times between CCM and non-CCM patients (p>0.05). At the end of follow-up, 5(6.1%) patients died. LAVi(P=0.049, HR 1.169, 95%CI [1.001-1.365]), MELD score(P=0.026, HR=3.082, 95%CI [1.142-8.319]) and preoperative RAP (p =0.044, HR=2.015, 95%CI [1.018-3.987])were significantly associated with the mortality. Conclusion: In conclusion, cirrhotic patients exhibit an effective regulatory capacity in response to hemodynamic alterations elicited by TIPS within short-term, irrespective of CCM presence.