Marco Francone MD, Presenter: Nothing to Disclose

Francesca Antonella Calabrese MD, Abstract Co-Author: Nothing to Disclose

Manuela Merli, Abstract Co-Author: Nothing to Disclose

Raffaele Lezoche, Abstract Co-Author: Nothing to Disclose

Carlo Catalano MD, Abstract Co-Author: Nothing to Disclose

Roberto Passariello MD, Abstract Co-Author: Nothing to Disclose

TIPS represents the best therapeutic option for treatment of portal hypertension in patients (pts) with cirrhosis and refractory ascites. Cirrhotic pts are characterized by an hyper-dynamic syndrome(HDS)with an increase of Cardiac Output(CO)and decrease of systemic vascular resistances. Additionally, HDS may be associated with myocardial fibrosis (MF). Purpose of the present study was to demonstrate presence and eventually a worsening of HDS in pts who underwent TIPS, and to identify signs of MF. CMR has emerged to be a preferred diagnostic tool for the evaluation of both systolic and diastolic function and for detection of MF and was therefore used as reference modality.

18 selected pts with clinical diagnosis of cirrhosis were referred to our Department for CMR evaluation before and within 21 days after TIPS implantation. A CMR study that included cine-SSFP imaging and VENC sequences was performed in all cases; DE acquisitions after contrast-administration were also used for detection of MF. Ejection fraction(EF),end-diastolic(EDV),end-systolic(ESV), cardiac output(CO) and early (E) and atrial (A)transmitral flow velocities were determined before and 1 month after TIPS implantation.

In 14/18 (77,7%)pts CMR revealed HS. EF increased from 45%±3,5% to 51%±1,3% after 1 month(P<0.05); EDV from 151mL±23mL to 185mL±17mL (P<0,05); ESV from 63mL±32mL; CO from 6,4L/min to 7,3L/min (P<0,05). Regarding indices of diastolic function, E wave increased significantly (p<0.05), however, because of a parallel increase in the A component, the E/A ratio did not show significant changes. Aspecific foci of DE were observed in 2 pts.

In pts with advanced cirrhosis and refractory ascites TIPS allows significant portal decompression. However HDS can deteriorate and TIPS should be considered with caution in pts with limited cardiac reserve. For this reason functional evaluation with CMR is useful before and after implantation of TIPS and may also allow detection of MF signs.

CMR allows accurate assessment of cardiac function in pts with portal hypertension and HDS who underwent to TIPS implantation and may be a useful diagnostic tool to depict signs of MF.

Francone, M, Calabrese, F, Merli, M, Lezoche, R, Catalano, C, Passariello, R, Cardiac MR (CMR) Evaluation of Hemodynamic Effects of Transjugular Intrahepatic Portosystemic Shunt (TIPS) on Cardiac Function of Patients with Cirrhosis (C).  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5014042.html