Right ventricular contractility predicts clearance of ascites after transjugular intrahepatic portosystemic shunt (TIPS)

Background and aims: One major drawback of TIPS implantation is deterioration of cardiac function probably due to unrecognized cirrhotic cardiomyopathy (CCM). Reduced left ventricular global longitudinal strain (LV-GLS) has been shown to be associated with development of acute and chronic liver failure (ACLF) and reduced prognosis. However, as right ventricular function may primarily be affected by increased blood shunting due to TIPS implantation, we hypothesized that reduced right ventricular global longitudinal strain (RV-GLS) may be associated with (I) ascites persistence and (II) with development of ACLF and (III) reduced prognosis.

Methods: 144 patients with TIPS implantation due to recurrent ascites and RV-GLS measurement in pre-TIPS echocardiography were included in this study (NCT05782556). Primary endpoint was ascites persistence, ACLF after TIPS and transplantation-free survival.

Results: Median RV-GLS was -21.3 [-24.6-(-17.7)]% before TIPS implantation. RV-GLS was significantly associated with ascites persistence after TIPS implantation (sHR 1.16 [1.09-1.23], p<0.001) adjusted for the FIPS score. RV-GLS was significantly worse (indicating less contractility) in patients with cardiac decompensation within 6 months after TIPS implantation (-17.7% vs. -21.8%; p=0.002; sHR 1.15 [1.05-1.25], p=0.003). Further, RV-GLS was also associated with the development of post-TIPS ACLF within 6 months (sHR 1.20 [1.11-1.29], p<0.001) and with reduced transplantation-free survival (HR 1.25 [1.03-1.54], p=0.025) adjusted for the FIPS score.

Conclusions: RV-GLS is an important predictor for ascites persistence and cardiac decompensation after TIPS implantation that my trigger ACLF and higher mortality. Therefore, RV-GLS may be a helpful additional tool for risk stratification in these patients.

Publication History

Article published online:
20 January 2025