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Long-term cardiovascular changes following creation of arteriovenous fistula in patients with end stage renal disease
YNV. Reddy, M. Obokata, PG. Dean, V. Melenovsky, KA. Nath, BA. Borlaug,
Language English Country England, Great Britain
Document type Journal Article
NLK
Free Medical Journals
from 1996 to 1 year ago
Open Access Digital Library
from 1996-01-01
- MeSH
- Arteriovenous Shunt, Surgical adverse effects MeSH
- Kidney Failure, Chronic physiopathology therapy MeSH
- Renal Dialysis MeSH
- Echocardiography MeSH
- Ventricular Function, Right physiology MeSH
- Cardio-Renal Syndrome etiology physiopathology MeSH
- Blood Pressure physiology MeSH
- Humans MeSH
- Cardiac Output physiology MeSH
- Plasma Volume physiology MeSH
- Postoperative Complications etiology physiopathology MeSH
- Ventricular Remodeling physiology MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Body Weight physiology MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
Aims: Short-term studies have reported left ventricular (LV) dilatation following surgical creation of arteriovenous fistulas (AVF) or arteriovenous grafts (AVGs), but chronic cardiac structural and functional changes have not been examined or related to clinical outcomes following AVF/AVG. We sought to characterize the long-term changes in cardiac structure and function in patients undergoing shunt creation for haemodialysis. Methods and results: A retrospective analysis was performed of patients undergoing echocardiography before and after surgical AVF/AVG creation for the initiation of haemodialysis. 137 patients underwent echocardiographic examinations prior to AVF and 2.6 years (median) after AVF creation. Following AVF and dialysis initiation, there were reductions in blood pressure, body weight and estimated plasma volume coupled with modest reverse LV remodelling. In contrast, AVF/AVG creation was associated with significant right ventricular (RV) dilatation and deterioration in RV function. Incident heart failure (HF) developed in 43% of patients in tandem with greater RV remodeling. The development of RV dilation following surgical AVF/AVG was independently associated with increased risk of death [HR 3.9, 95% CI (1.7-9.2), P = 0.001]. Conclusion: In long-term follow-up, RV remodelling and dysfunction develop following AVF/AVG creation and dialysis initiation, despite improved control of LV pressure load through dialysis. Deleterious effects on right heart structure and function are coupled with development of incident HF and increased risk of death. Further study is required to identify patients at greatest risk for detrimental AVF/AVG changes who may benefit from alternate forms of dialysis or potentially ligation of existing AVF.
Department of Cardiology IKEM Videnska 1958 9 Prague 4 140 28 Czech Republic
Department of Cardiovascular Medicine Mayo Clinic 200 1st St SW Rochester Minnesota 55905 USA
Division of Nephrology and Hypertension Mayo Clinic 200 1st St SW Rochester Minnesota 55905 USA
Division of Transplantation Surgery Mayo Clinic 200 1st St SW Rochester Minnesota 55905 USA
References provided by Crossref.org
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- $a Aims: Short-term studies have reported left ventricular (LV) dilatation following surgical creation of arteriovenous fistulas (AVF) or arteriovenous grafts (AVGs), but chronic cardiac structural and functional changes have not been examined or related to clinical outcomes following AVF/AVG. We sought to characterize the long-term changes in cardiac structure and function in patients undergoing shunt creation for haemodialysis. Methods and results: A retrospective analysis was performed of patients undergoing echocardiography before and after surgical AVF/AVG creation for the initiation of haemodialysis. 137 patients underwent echocardiographic examinations prior to AVF and 2.6 years (median) after AVF creation. Following AVF and dialysis initiation, there were reductions in blood pressure, body weight and estimated plasma volume coupled with modest reverse LV remodelling. In contrast, AVF/AVG creation was associated with significant right ventricular (RV) dilatation and deterioration in RV function. Incident heart failure (HF) developed in 43% of patients in tandem with greater RV remodeling. The development of RV dilation following surgical AVF/AVG was independently associated with increased risk of death [HR 3.9, 95% CI (1.7-9.2), P = 0.001]. Conclusion: In long-term follow-up, RV remodelling and dysfunction develop following AVF/AVG creation and dialysis initiation, despite improved control of LV pressure load through dialysis. Deleterious effects on right heart structure and function are coupled with development of incident HF and increased risk of death. Further study is required to identify patients at greatest risk for detrimental AVF/AVG changes who may benefit from alternate forms of dialysis or potentially ligation of existing AVF.
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