Impact of Transjugular Intrahepatic Portosystemic Shunting (TIPS) on Cardiac Function in Patients with Portal Hypertension

Elevated pressure in the portal venous system (e.g., portal hypertension) is the primary physiologic complication in patients with cirrhosis or other forms of chronic liver disease. The transjugular intrahepatic portosystemic shunt (TIPS), which is an artificial stent that is employed to reduce portal pressure, is an effective treatment for many of the complications of portal hypertension. TIPS is commonly used as a bridge to liver transplantation. However, recent advancements in procedural technique and technological progress in the stent design itself, has led to expanded use of TIPS as destination therapy for the complications of portal hypertension among patients who are not eligible for liver transplantation. The goal of this proposal is to evaluate the cardiac effects of contemporary use of TIPS in patients with portal hypertension. We hypothesize that ongoing myocardial stress from increased volume load to the ventricles in the setting of TIPS leads to myocardial remodeling and alterations in cardiac structure and function that results in clinical heart failure. Aims (Objectives): 1. To describe the distribution and patterns of echocardiogram-derived indices of cardiac mechanics (e.g., strain measures) and circulating cardiac biomarkers (e.g., hs-troponin and NT-pro BNP) following TIPS. 2. To describe change over time in echocardiogram-derived markers of cardiac mechanics and circulating cardiac biomarkers following TIPS. 3. To identify patterns of cardiac mechanics and circulating cardiac biomarkers among TIPS recipients that are associated with differential risk for morbidity and mortality prior to and after liver transplantation. The above represent our ultimate aims. The proposed pilot project will allow us to demonstrate feasibility and start to develop power and sample size calculations for later grant submissions.