Despite several studies showing increased mus-
cle mass, quality of life and exercise capacity after short intensive
physical activity programmes, there is no existing evidence suggest-
ing that these interventions alter waitlist or post‐transplant out-
Given the strong associations found in the literature with
poor patient outcomes as well as the concerning signals noted in the
study by Bhanji et al, a controlled, prospective study is warranted to
track outcomes and body composition changes, and test the efficacy
of interventions for this important problem.
The writing and preparation of this paper were funded in part by NIH
grant T32DK077662 PI MM Abecassis. Drs. Mazumder and Rinella
wrote the paper. Dr. Rinella designed and created the figure. Dr.
Rinella takes responsibility for the integrity of the work as a whole,
from inception to published article. All authors approved the final ver-
sion of the manuscript. Dr. Mazumder was funded in part by NIH
grant T32DK077662 PI MM Abecassis. Dr. Rinella provides consult-
ing services to the following companies and organizations: Intercept,
Gilead, Genfit, Enanta, BMS, Novartis, NGM Bio, Immuron, Cymabay,
Merck, Viking, Gelesis, Allergan, Metacrine, Thetis, Fractyl and
Chronic Liver Disease Foundation (CLDF). She is on scientific advisory
boards for the following companies: Intercept, Gilead, Enanta, Novar-
tis and NGM Bio. She has received independent research funding
from Novartis. She is on no Speakers Bureaus and owns no stock in
companies with which she has any involvement. She serves as an
Associate Editor for Hepatology and Seminars in Liver Disease.
Nikhilesh Mazumder https://orcid.org/0000-0001-9749-5334
This article is linked to Bhanji et al paper. To view this article, visit
Division of Hepatology, Department of Medicine Feinberg School of
Medicine, Northwestern University, Chicago, Illinois
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Editorial: diastolic dysfunction seems not to be decisive for
survival after transjugular intrahepatic portosystemic stent‐shunt
Armstrong et al take a closer look at cardiac diagnostics in patients eval-
uated for transjugular intrahepatic portosystemic stent‐shunt (TIPSS)
Although highly selected in their patients, presence of dias-
tolic dysfunction was not associated with survival, but Model for End‐
Stage Liver Disease (MELD) score remained the best predictor of
survival. The clinical “gut‐feeling”and pathophysiological understanding
suggest that the cardiac function should play a role and should be inves-
tigated prior to TIPSS insertion in these patients.
Therefore, the ques-
tion arises, is echocardiography relevant for selection of patients to
TIPSS and if yes what parameters are the relevant ones?
©2019 John Wiley & Sons Ltd