Transjugular intrahepatic portosystemic shunt: impact on systemic hemodynamics and renal and cardiac function in patients with cirrhosis

Autor: Magnus T. Jensen, Sören Möller, Jens P. Goetze, Flemming Bendtsen, Jesper N. Bech, Jens Otto Clemmesen, Fin Stolze Larsen, Rasmus Mogelvang, Troels M. Busk, Erling B. Pedersen, Jens S. Iversen, Jørgen Hjelm Poulsen
Rok vydání: 2018
Předmět:
Liver Cirrhosis
Male
Cardiac function curve
medicine.medical_specialty
Cardiac output
Time Factors
Cirrhosis
Physiology
medicine.medical_treatment
Portal venous pressure
Natriuresis
Renal function
030204 cardiovascular system & hematology
Doppler echocardiography
Kidney
Electrocardiography
03 medical and health sciences
0302 clinical medicine
Heart Rate
Physiology (medical)
Internal medicine
Hypertension
Portal
Humans
Medicine
Cardiac Output
Aged
Blood Volume
Hepatology
medicine.diagnostic_test
business.industry
Gastroenterology
Heart
Recovery of Function
Middle Aged
medicine.disease
Portal Pressure
Echocardiography
Doppler
Cirrhotic cardiomyopathy
Treatment Outcome
Cardiology
Female
030211 gastroenterology & hepatology
Portasystemic Shunt
Transjugular Intrahepatic
Cardiomyopathies
business
Transjugular intrahepatic portosystemic shunt
Biomarkers
Glomerular Filtration Rate
Zdroj: Busk, T M, Bendtsen, F, Poulsen, J H, Clemmensen, J O, Larsen, F S, Gøtze, J P, Iversen, J S, Jensen, M T, Møgelvang, R, Pedersen, E B, Bech, J N & Møller, S 2018, ' Transjugular intrahepatic portosystemic shunt: Impact on systemic hemodynamics and renal and cardiac function in patients with cirrhosis. ', American Journal of Physiology: Gastrointestinal and Liver Physiology, vol. 314, pp. G275-G286 . https://doi.org/10.1152/ajpgi.00094.2017
ISSN: 1522-1547
0193-1857
Popis: Transjugular intrahepatic portosystemic shunt (TIPS) alleviates portal hypertension and possibly increases central blood volume (CBV). Moreover, renal function often improves; however, its effects on cardiac function are unclear. The aims of our study were to examine the effects of TIPS on hemodynamics and renal and cardiac function in patients with cirrhosis. In 25 cirrhotic patients, we analyzed systemic, cardiac, and splanchnic hemodynamics by catheterization of the liver veins and right heart chambers before and 1 wk after TIPS. Additionally, we measured renal and cardiac markers and performed advanced echocardiography before, 1 wk after, and 4 mo after TIPS. CBV increased significantly after TIPS (+4.6%, P < 0.05). Cardiac output (CO) increased (+15.3%, P < 0.005) due to an increase in stroke volume (SV) (+11.1%, P < 0.005), whereas heart rate (HR) was initially unchanged. Cardiopulmonary pressures increased after TIPS, whereas copeptin, a marker of vasopressin, decreased (−18%, P < 0.005) and proatrial natriuretic peptide increased (+52%, P < 0.0005) 1 wk after TIPS and returned to baseline 4 mo after TIPS. Plasma neutrophil gelatinase-associated lipocalin, renin, aldosterone, and serum creatinine decreased after TIPS (−36%, P < 0.005; −65%, P < 0.05; −90%, P < 0.005; and −13%, P < 0.005, respectively). Echocardiography revealed subtle changes in cardiac function after TIPS, although these were within the normal range. TIPS increases CBV by increasing CO and SV, whereas HR is initially unaltered. These results indicate an inability to increase the heart rate in response to a hemodynamic challenge that only partially increases CBV after TIPS. These changes, however, are sufficient for improving renal function. NEW & NOTEWORTHY For the first time, we have combined advanced techniques to study the integrated effects of transjugular intrahepatic portosystemic shunt (TIPS) in cirrhosis. We showed that TIPS increases central blood volume (CBV) through improved cardiac inotropy. Advanced echocardiography demonstrated that myocardial function was unaffected by the dramatic increase in preload after TIPS. Finally, renal function improved due to the increase in CBV. Recognition of these physiological changes significantly contributes to our clinical understanding of TIPS.
Databáze: OpenAIRE
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