Cardiac assessment and TIPSS: cirrhotic cardiomyopathy, investigations and postprocedural management

Transjugular intrahepatic portosystemic shunt (TIPSS) procedures are one of the few interventions aside from liver transplantation that can be used to manage portal hypertensive complications in cirrhosis and result in a significant improvement in patients’ morbidity and mortality. However, cardiac decompensation following TIPSS is a not-infrequent occurrence. This may be due to underlying cirrhotic cardiomyopathy or other pre-existing cardiac conditions and may significantly impact on the subsequent quality and length of life. As such, it is an important consideration when determining patients’ suitability to electively undergo a TIPSS procedure. The currently employed screening methods include a combination of clinical assessment, blood tests including N-terminal pro B-type natriuretic peptide (NT-proBNP) and echocardiograms, but there is variation in the parameters and thresholds utilised to aid in this decision.

In this review, we examine recent developments in the definition of cirrhotic cardiomyopathy and the impact this has had on the current evidence base and proposed screening tests for cardiac decompensation post-TIPSS as well as recommendations for the assessment and management of these patients.