目的:经颈静脉肝内门体分流术(TIPS)的放置导致中央循环血容量突然增加,这需要对心血管系统进行适当的调节。我们旨在研究TIPS对肝硬化心肌病(CCM)的影响。
方法:连续一系列接受TIPS的肝硬化患者在接受TIPS之前通过超声心动图和压力测量进行评估,TIPS后立即和2-4天后(延迟)。此外,所有患者均接受1年随访.
结果:在这项研究中,纳入107例患者,38(35.5%)与CCM。超声心动图显示术后左心室充盈压升高,并伴有左心室射血分数(LVEF)升高。然而,与非CCM组相比,CCM组患者的LVEF和平均动脉压(MAP)较低.后提示,CCM患者显示右心房压(RAP)升高,在2-4天内恢复正常。而非CCM患者的RAP低于基线水平.与没有CCM的患者相比,CCM患者显示即时较低(16.7±4.4vs.18.9±4.8,p=0.022)和延迟15.9±3.7与17.7±5.3,p=0.044)门静脉压力(PVP)和门静脉压力梯度(PPG)(7.7±3.4vs.9.2±3.6,p=0.032和10.1±3.1vs.12.3±4.9,p=0.013)。CCM患者的1年死亡率为13.2%,非CCM患者为4.3%(对数秩检验,p=0.093),MELD得分,术前RAP与死亡率显著相关。
结论:患有CCM的肝硬化患者在TIPS后立即和2-4天后表现出更低的PVP和PPG,在不显著影响一年生存结果的情况下。
OBJECTIVE: The placement of Transjugular intrahepatic portosystemic shunt (TIPS) results in a sudden increase in central circulating blood volume, which requires proper regulation of the cardiovascular system. We aimed to investigate the impact of TIPS on cirrhotic cardiomyopathy (CCM).
METHODS: A consecutive case series of patients with cirrhosis who underwent TIPS were evaluated by echocardiography and pressure measurements before, immediately after TIPS and 2-4 days later (delayed). Furthermore, all patients underwent a one-year follow-up.
RESULTS: In this study, 107 patients were enrolled, 38 (35.5%) with CCM. Echocardiography revealed an increase in postoperative left ventricular filling pressure accompanied by an elevation in left ventricular ejection fraction (LVEF). However, patients in the CCM group exhibited lower LVEF and mean arterial pressure (MAP) compared to the non-CCM group. Post-TIPS, CCM patients showed increased right atrium pressure (RAP) that normalized within 2-4 days, whereas non-CCM patients had lower RAP than baseline. Compared to patient without CCM, CCM patients revealed lower immediate (16.7 ± 4.4 vs. 18.9 ± 4.8, p = 0.022) and delayed 15.9 ± 3.7 vs. 17.7 ± 5.3, p = 0.044) portal vein pressures (PVP) and portal pressure gradients (PPG) (7.7 ± 3.4 vs. 9.2 ± 3.6, p = 0.032 and 10.1 ± 3.1 vs. 12.3 ± 4.9, p = 0.013). The 1-year mortality rates were 13.2% for CCM patients and 4.3% for non-CCM patients (log-rank test, p = 0.093), with MELD score, and preoperative RAP significantly associated with the mortality.
CONCLUSIONS: Cirrhotic patients with CCM exhibit lower PVP and PPG immediately after TIPS and 2-4 days later, without significantly impacting one-year survival outcomes.