Circulatory response to volume expansion and transjugular intrahepatic portosystemic shunt in refractory ascites: Relationship with diastolic dysfunction

被引：20

作者：

Fili, Daniela ^{[1
]}

Falletta, Calogero ^{[2
]}

Luca, Angelo ^{[3
]}

Baravoglia, Cesar Hernandez ^{[2
]}

Clemenza, Francesco ^{[2
]}

Miraglia, Roberto ^{[4
]}

Scardulla, Cesare ^{[2
]}

Tuzzolino, Fabio ^{[5
]}

Vizzini, Giovanni ^{[1
]}

Gridelli, Bruno ^{[6
]}

Bosch, Jaime ^{[7
,8
]}

机构：

[1] IRCCS ISMETT Mediterranean Inst Transplantat & Ad, Dept Treatment & Study Abdominal Dis & Abdominal, Hepatol Unit, Palermo, Italy

[2] IRCCS ISMETT Mediterranean Inst Transplantat & Ad, Dept Treatment & Study Cardiothorac Dis & Cardiot, Cardiol Unit, Palermo, Italy

[3] IRCCS ISMETT Mediterranean Inst Transplantat & Ad, Dept Diagnost & Therapeut Serv, Palermo, Italy

[4] IRCCS ISMETT Mediterranean Inst Transplantat & Ad, Dept Diagnost & Therapeut Serv, Serv Radiol, Palermo, Italy

[5] Univ Palermo, Dept Econ Business & Stat Sci, Palermo, Italy

[6] IRCCS ISMETT Mediterranean Inst Transplantat & Ad, Dept Treatment & Study Abdominal Dis & Abdominal, Palermo, Italy

[7] Univ Barcelona, Hosp Clin, Liver Unit, Barcelona, Spain

[8] CIBERehd, Barcelona, Spain

来源：

DIGESTIVE AND LIVER DISEASE | 2015年 / 47卷 / 12期

关键词：

Cirrhosis; Echocardiography; Heart failure; Right heart catheterization; Transjugular portosystemic shunt; NATRIURETIC PEPTIDE BNP; CIRRHOTIC CARDIOMYOPATHY; LIVER-TRANSPLANTATION; CARDIAC-FUNCTION; HEART; HEMODYNAMICS; SURVIVAL; DISEASE; DYSPNEA; PROBNP;

D O I：

10.1016/j.dld.2015.08.014

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Background: Cirrhotic cardiomyopathy may lead to heart failure in stressful circumstances, such as after transjugular intrahepatic portosystemic shunt (TIPS) placement. Aim: To examine whether acute volume expansion predicts haemodynamic changes after TIPS and elicits signs of impending heart failure. Methods: We prospectively evaluated refractory ascites patients (group A) and compensated cirrhotics (group B), who underwent echocardiography, NT-proBNP measurement, and heart catheterization before and after volume load; group A repeated measurements after TIPS. Results: 15 patients in group A (80% male; 54 +/- 12.4 years) and 8 in group B (100% male; 56 +/- 6.2 years) were enrolled. Echocardiography disclosed diastolic dysfunction in 30% and 12.5%, respectively. In group A, volume load and TIPS induced a significant increase in right atrial, mean pulmonary, capillary wedge pressure and cardiac index, and a decrease in systemic vascular resistance (respectively, 4.7 +/- 2.8 vs. 9.9 +/- 3.6 mmHg; 13.3 +/- 3.5 vs. 21.9 +/- 5.9 mmHg; 8.3 +/- 3.4 vs. 15.4 +/- 4.7 mmHg; 3.7 +/- 0.7 vs. 4.6 +/- 1 lt/min/m(2); 961 +/- 278 vs. 767 +/- 285 dyn s cm(-5); and 10.1 +/- 3.3 vs. 14.2 +/- 3.4 mmHg; 17.5 +/- 4 vs. 25.2 +/- 4.2 mmHg; 12.3 +/- 4 vs. 19.3 +/- 3.4 mmHg; 3.4 +/- 0.8 vs. 4.5 +/- 0.91 lt/min/m(2); 779 +/- 62 vs. 596 +/- 199 dyn s cm(-5), p < 0.001 for all pairs). At 24 h, cardiopulmonary pressures returned towards baseline. Conclusions: Acute volume expansion predicted haemodynamic changes immediately after TIPS. All patients had adequate haemodynamic adaptation to TIPS; none developed signs of heart failure. (c) 2015 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

引用

页码：1052 / 1058

页数：7

共 40 条

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