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

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Standard

Transjugular intrahepatic portosystemic shunt : impact on systemic hemodynamics and renal and cardiac function in patients with cirrhosis. / Busk, Troels M; Bendtsen, Flemming; Poulsen, Jørgen H; Clemmesen, Jens O; Larsen, Fin S; Goetze, Jens P; Iversen, Jens S.; Jensen, Magnus T; Møgelvang, Rasmus; Pedersen, Erling B; Bech, Jesper N; Møller, Søren.

I: American Journal of Physiology: Gastrointestinal and Liver Physiology, Bind 314, Nr. 2, 2018, s. G275-G286.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningfagfællebedømt

Harvard

Busk, TM, Bendtsen, F, Poulsen, JH, Clemmesen, JO, Larsen, FS, Goetze, JP, Iversen, JS, Jensen, MT, Møgelvang, R, Pedersen, EB, Bech, JN & 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, bind 314, nr. 2, s. G275-G286. https://doi.org/10.1152/ajpgi.00094.2017

APA

Busk, T. M., Bendtsen, F., Poulsen, J. H., Clemmesen, J. O., Larsen, F. S., Goetze, J. P., ... 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, 314(2), G275-G286. https://doi.org/10.1152/ajpgi.00094.2017

Vancouver

Busk TM, Bendtsen F, Poulsen JH, Clemmesen JO, Larsen FS, Goetze JP o.a. 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. 2018;314(2):G275-G286. https://doi.org/10.1152/ajpgi.00094.2017

Author

Busk, Troels M ; Bendtsen, Flemming ; Poulsen, Jørgen H ; Clemmesen, Jens O ; Larsen, Fin S ; Goetze, Jens P ; Iversen, Jens S. ; Jensen, Magnus T ; Møgelvang, Rasmus ; Pedersen, Erling B ; Bech, Jesper N ; Møller, Søren. / Transjugular intrahepatic portosystemic shunt : impact on systemic hemodynamics and renal and cardiac function in patients with cirrhosis. I: American Journal of Physiology: Gastrointestinal and Liver Physiology. 2018 ; Bind 314, Nr. 2. s. G275-G286.

Bibtex

@article{e48df5229ed046bfb126f7934382800b,
title = "Transjugular intrahepatic portosystemic shunt: impact on systemic hemodynamics and renal and cardiac function in patients with cirrhosis",
abstract = "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.",
keywords = "Aged, Biomarkers/blood, Blood Volume, Cardiac Output, Cardiomyopathies/diagnostic imaging, Echocardiography, Doppler, Electrocardiography, Female, Glomerular Filtration Rate, Heart/diagnostic imaging, Heart Rate, Humans, Hypertension, Portal/diagnosis, Kidney/physiopathology, Liver Cirrhosis/complications, Male, Middle Aged, Natriuresis, Portal Pressure, Portasystemic Shunt, Transjugular Intrahepatic, Recovery of Function, Time Factors, Treatment Outcome",
author = "Busk, {Troels M} and Flemming Bendtsen and Poulsen, {J{\o}rgen H} and Clemmesen, {Jens O} and Larsen, {Fin S} and Goetze, {Jens P} and Iversen, {Jens S.} and Jensen, {Magnus T} and Rasmus M{\o}gelvang and Pedersen, {Erling B} and Bech, {Jesper N} and S{\o}ren M{\o}ller",
year = "2018",
doi = "10.1152/ajpgi.00094.2017",
language = "English",
volume = "314",
pages = "G275--G286",
journal = "American Journal of Physiology: Gastrointestinal and Liver Physiology",
issn = "0193-1857",
publisher = "American Physiological Society",
number = "2",

}

RIS

TY - JOUR

T1 - Transjugular intrahepatic portosystemic shunt

T2 - impact on systemic hemodynamics and renal and cardiac function in patients with cirrhosis

AU - Busk, Troels M

AU - Bendtsen, Flemming

AU - Poulsen, Jørgen H

AU - Clemmesen, Jens O

AU - Larsen, Fin S

AU - Goetze, Jens P

AU - Iversen, Jens S.

AU - Jensen, Magnus T

AU - Møgelvang, Rasmus

AU - Pedersen, Erling B

AU - Bech, Jesper N

AU - Møller, Søren

PY - 2018

Y1 - 2018

N2 - 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.

AB - 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.

KW - Aged

KW - Biomarkers/blood

KW - Blood Volume

KW - Cardiac Output

KW - Cardiomyopathies/diagnostic imaging

KW - Echocardiography, Doppler

KW - Electrocardiography

KW - Female

KW - Glomerular Filtration Rate

KW - Heart/diagnostic imaging

KW - Heart Rate

KW - Humans

KW - Hypertension, Portal/diagnosis

KW - Kidney/physiopathology

KW - Liver Cirrhosis/complications

KW - Male

KW - Middle Aged

KW - Natriuresis

KW - Portal Pressure

KW - Portasystemic Shunt, Transjugular Intrahepatic

KW - Recovery of Function

KW - Time Factors

KW - Treatment Outcome

U2 - 10.1152/ajpgi.00094.2017

DO - 10.1152/ajpgi.00094.2017

M3 - Journal article

C2 - 29074483

VL - 314

SP - G275-G286

JO - American Journal of Physiology: Gastrointestinal and Liver Physiology

JF - American Journal of Physiology: Gastrointestinal and Liver Physiology

SN - 0193-1857

IS - 2

ER -

ID: 215460269