Cardiovascular magnetic resonance reveals stable myocardial tissue characteristics despite cardiac remodelling after transjugular intrahepatic portosystemic shunt in liver cirrhosis.

AIMS: Transjugular intrahepatic portosystemic shunt (TIPS) reduces portal hypertension in liver cirrhosis but acutely increases cardiac preload. The present study aimed to prospectively assess changes in cardiac function, remodelling, and myocardial tissue characteristics after TIPS using cardiovascular magnetic resonance (CMR). METHODS AND RESULTS: Of the 45 screened patients with advanced liver cirrhosis, 23 patients [median (IQR) age 65 (56-69) years, 70% male, 87% Child-Pugh class B, MELD score 14 (12-20)] were prospectively included and underwent multiparametric CMR before TIPS implantation (CMR-1), as well as follow-up imaging after 3 (2-4) days (CMR-2, n = 20) and 100 (87-122) days (CMR-3, n = 10). Biventricular end-diastolic volumes increased significantly from baseline to the final follow-up (CMR-3) [left ventricle (LV) +27.2 (20.8-38.6) mL/m2; right ventricle (RV) +26.1 (18.2-38.0) mL/m2; both P < 0.001], accompanied by increased stroke volumes [LV +7.2 (3.6-15.7) mL/m2, RV +9.8 (2.3-15.4) mL/m2; both P < 0.001]. LV mass increased from 32 (30-37) g/m2 to 47 (45-52) g/m2 (P < 0.001). Although extracellular volume (ECV) fraction remained unchanged [27 (23-28) % vs. 25 (23-29) %; P = 0.06], ECV mass increased from 17.1 (14.0-21.8) g to 25.4 (20.7-27.4) g (P < 0.001), reflecting the concomitant increase in LV mass. Myocardial tissue characterization revealed no significant changes in native T1 or T2 values during follow-up (all P > 0.05). CONCLUSION: TIPS implantation induces progressive biventricular dilatation, increased stroke volume, and eccentric remodelling. Despite these marked structural adaptations, myocardial tissue characteristics remained largely unchanged during short- and mid-term follow-up, suggesting predominantly preload-driven cardiac remodelling.