Relevance of the Diagnostic Criteria for Diastolic Dysfunction in Patients With Transjugular Intrahepatic Portosystemic Shunt

Background & aims: Cirrhotic cardiomyopathy (CCM), particularly diastolic dysfunction (DD), often remains silent until stress occurs. Transjugular intrahepatic portosystemic shunt (TIPS) may unmask DD due to hemodynamic shifts. However, data supporting the utility in selecting patients before TIPS of new CCM criteria and DD remains inconclusive. We aim to assess the impact of TIPS on post-procedural cardiac and liver outcomes, using different CCM criteria. Methods: We retrospectively studied cirrhotic patients who underwent TIPS between January 2014 and December 2022. Demographic, clinical, echocardiographic and hemodynamic data were collected, along with 6-month outcomes: major cardiovascular events (MACE), liver transplant (LT) and death. DD was assessed through 2005 and 2019 criteria. Results: We included 184 patients (71% male, mean age 56 [IQR 53-54]). DD prevalence was 90% with 2005 and 25% with 2019 criteria. MACE occurred in 8% and mostly early post-TIPS. Patients with DD (2019 criteria) were older (62 vs. 56 years, p = 0.001) and had higher NT-proBNP (165 vs. 87 pg/mL, p = 0.05), but no increased rate of MACE (11% vs. 3%; p = 0.29) or composite LT/death (14% vs. 18%; p = 0.55) were observed. No independent MACE predictors emerged. Conversely, liver disease severity, assessed by MELD (HR 1.36, 95% CI 1.18-1.56, p < 0.001) and pre-TIPS portal pressure gradient (HR 1.10, 95% CI 1.01-1.21, p = 0.038), was independently associated with LT-free survival. Conclusions: New DD criteria have limited predictive value for adverse outcomes post-TIPS. In contrast, liver disease severity emerged as the predominant predictor of outcome, underscoring its importance in patient selection.