Cardiac function and haemodynamics in alcoholic cirrhosis and effects of the transjugular intrahepatic portosystemic stent shunt

Background-A portosystemic stent shunt may impair cardiac function and haem odynamics. Aims-To investigate the effects of a transjugular intrahepatic portosystemi c shunt (TIPS) on cardiac function and pulmonary and systemic circulation i n patients with alcoholic cirrhosis. Patients/Methods-17 patients with alcoholic cirrhosis and recent variceal b leeding were evaluated by echocardiography and catheterisation of the splan chnic and pulmonary circulation before and after TIPS. The period of cathet er measurement was extended to nine hours in nine of the patients. The port al vein was investigated by Doppler ultrasound before and nine hours after TIPS. Results-Baseline echocardiography showed the left atrial diameter to be sli ghtly increased and the left ventricular volume to be in the upper normal r ange. Nine hours after TIPS, the left atrial diameter and left ventricular end diastolic volume were increased (by 6% (p<0.01) and 7% (p<0.01) respect ively); end systolic volume had not changed significantly. Invasive measure ments showed a sharp increase in right atrial pressure (by 101%; p<0.01), m ean pulmonary artery pressure (by 92%; p<0.01), pulmonary capillary wedge p ressure (by 111%; p<0.01), and cardiac output (8.1 (1.6) to 11.9 (2.4) l/mi n; p<0.01). Systemic vascular resistance decreased (824 (242) to 600 (265) dyn.s.cm(-5) p<0.01), and total pulmonary resistance increased (140 (58.5) to 188 (69.5) dyn.s.cm(-5); p<0.05). Total pulmonary resistance (12%; NS), cardiac output (1.4 l/min; p<0.05), and portal vein blood flow (1.4 l/min; p<0.05) remained elevated for nine hours after TIPS in the subgroup. Portoa trial pressure gradient (43%; p<0.05), portohepatic vascular resistance (72 %; p<0.05), and systemic vascular resistance (27%; p<0.01) were consistentl y reduced. Conclusions The increase in the left atrial diameter, the pulmonary capilla ry wedge pressure, and total pulmonary resistance observed after the TIPS p rocedure reflected diastolic dysfunction of the hyperdynamic left ventricle in patients with alcoholic cirrhosis. The haemodynamic effects of the port osystemic stent shunt itself on the splanchnic circulation seem to be mainl y responsible for the further decrease in systemic vascular resistance. TIP S may unmask a coexisting preclinical cardiomyopathy in patients with alcoh olic cirrhosis and portal hypertension.