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

Troels M Busk, Flemming Bendtsen, Jørgen H Poulsen, Jens O Clemmesen, Fin S Larsen, Jens P Goetze, Jens S Iversen, Magnus T Jensen, Rasmus Møgelvang, Erling B Pedersen, Jesper N Bech, Søren Møller

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 week after TIPS. Additionally, we measured renal and cardiac markers and performed advanced echocardiography before, one week after, and four months 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 pro-atrial natriuretic peptide increased (+52%, p<0.0005) one week after TIPS, and returned to baseline four months after TIPS. Plasma NGAL, 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.