Filì Daniela, Falletta Calogero, Luca Angelo, Hernandez Baravoglia Cesar, Clemenza Francesco, Miraglia Roberto, Scardulla Cesare, Tuzzolino Fabio, Vizzini Giovanni, Gridelli Bruno, Bosch Jaime
Hepatology Unit, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS - ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy.
Cardiology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS - ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy.
Dig Liver Dis. 2015 Dec;47(12):1052-8. doi: 10.1016/j.dld.2015.08.014. Epub 2015 Sep 3.
Cirrhotic cardiomyopathy may lead to heart failure in stressful circumstances, such as after transjugular intrahepatic portosystemic shunt (TIPS) placement.
To examine whether acute volume expansion predicts haemodynamic changes after TIPS and elicits signs of impending heart failure.
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.
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±11 t/min/m2; 961±278 vs. 767±285 dynscm(-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±0.91l t/min/m2; 779±62 vs. 596±199 dynscm(-5), p<0.001 for all pairs). At 24h, cardiopulmonary pressures returned towards baseline.
Acute volume expansion predicted haemodynamic changes immediately after TIPS. All patients had adequate haemodynamic adaptation to TIPS; none developed signs of heart failure.
肝硬化性心肌病在诸如经颈静脉肝内门体分流术（TIPS）放置后的应激情况下可能导致心力衰竭。
研究急性容量扩张是否可预测TIPS术后的血流动力学变化并引发即将发生心力衰竭的体征。
我们前瞻性评估了难治性腹水患者（A组）和代偿期肝硬化患者（B组），这些患者在容量负荷前后接受了超声心动图、NT-proBNP测量和心导管检查；A组在TIPS术后重复测量。
A组纳入15例患者（80%为男性；54±12.4岁），B组纳入8例患者（100%为男性；56±6.2岁）。超声心动图分别显示30%和12.5%的患者存在舒张功能障碍。在A组中，容量负荷和TIPS导致右心房、平均肺动脉、毛细血管楔压和心脏指数显著升高，全身血管阻力降低（分别为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±11 l t/min/m2；961±278 vs. 767±285 dynscm(-5)；以及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±0.9 l t/min/m2；779±62 vs. 596±199 dynscm(-5)，所有配对p<0.001）。在24小时时，心肺压力恢复至基线水平。
急性容量扩张可预测TIPS术后即刻的血流动力学变化。所有患者对TIPS均有充分的血流动力学适应；无一例出现心力衰竭体征。
