Efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) created using covered stents of different diameters: A systematic review and meta-analysis

PurposeThe purpose of this study was to make a systematic review and meta-analysis to determine the stent diameter (8 mm vs. 10 mm) that conveys better safety and clinical efficacy for transjugular intrahepatic portosystemic shunt (TIPS).Materials and methodsFour databases were used to identify clinical trials published from inception until March 2020. Data were extracted to estimate and compare one-year and three-year overall survivals, hepatic encephalopathy, variceal rebleeding, and shunt dysfunction rates between patients with 8 mm covered stents and those with 10 mm covered stents.ResultsFive eligible studies were selected, which included 489 patients (316 men, 173 women). The 8 mm covered stent group had higher efficacy regarding one-year or three-year overall survival (odds ratio [OR], 2.88; P = 0.003) and (OR, 1.81; P = 0.04) and lower hepatic encephalopathy (OR, 0.69; P = 0.04) compared with 10 mm covered stent group. There were no significant differences in variceal rebleeding rate (OR 0.80; P = 0.67). However, shunt dysfunction was lower in 10 mm covered stent group (OR, 2.26; P = 0.003).ConclusionsOur results suggest that the use of 8 mm covered stents should be preferred to that of 10 mm covered stents for TIPS placement when portal pressure is frequently monitored.     

Left ventricular and atrial strain imaging with cardiac computed tomography: Validation against echocardiography

BackgroundData on left ventricular (LV) deformation imaging using CT angiography (CTA) are scarce and the feasibility of atrial deformation analysis by CT has not been addressed. We aimed to compare 2D echocardiographic and CT derived LV and left atrial (LA) global longitudinal strain (GLS) obtained by using a novel feature tracking algorithm in patients following transcatheter aortic valve implantation.MethodsTwenty-eight patients were included who underwent retrospectively-gated 256-slice CTA and speckle-tracking echocardiography (STE) on the same day. CT datasets in 10% increments were reconstructed throughout the cardiac cycle. LV GLS and LA global peak reservoir strain (LA GS) was measured.ResultsMedian absolute values for LV GLS were 19.9 [14.8–22.4] vs. 19.9 [16.8–24.7], as measured by CT vs STE, respectively (p = 0.017). We found good inter-modality correlation for LV GLS (ρ = 0.78, p < 0.05) with a mean bias of −1.6. Regarding atrial measurements, the median LA GS was 19.0 [13.5–27.3] for CT vs. 28.0 [17.5–32.6] for STE (p < 0.001) with a mean bias of −5.6 between CT and STE and a correlation coefficient of ρ = 0.87, p < 0.001. CT measurements were highly reproducible: intra-observer intra-class correlation coefficient was 0.96 for LV GLS and 0.95 for LA GS.ConclusionWe detected good correlation between CTA and echocardiography-based LV and LA longitudinal strain parameters. CTA provides accurate strain measurements with high reproducibility. Feature tracking-based deformation analysis could provide a clinically important addition to CT examinations by complementing anatomical information with functional data.