In patients with end-stage renal disease, excessive blood flow through an arteriovenous fistula (AVF) may lead to volume overload-induced cardiac remodeling and heart failure. It is unclear which patients with hyperfunctional AVF may benefit from AVF reduction or ligation. The indication for the procedure is often based on AVF flow. Because cardiac remodeling is driven by increased venous return, which is equivalent to cardiac output, we hypothesized that an elevated cardiac index (CI) might better identify subjects with reverse remodeling after AVF reduction. Thirty patients (age 52±12 years, 73% male) with AVF flow ⩾1.5 l min(-1) underwent comprehensive echocardiographic evaluations before and after AVF reduction. At baseline, 16 patients had a normal CI (2.5-3.8 l min(-1) m(-2)) and 14 had a high CI (4.0-6.0 l min(-1) m(-2)). A left ventricular end-diastolic diameter decrease after operation was predicted by elevated baseline CI (P<0.01), but not elevated AVF flow (P=0.07). There was a significant decrease in CI, left ventricular mass, left atrial and right ventricular diameter and pulmonary systolic pressure in the high CI group but not in the normal CI group. After AVF reduction, systemic vascular resistance decreased in the normal CI group, whereas it did not change in the high CI group. In conclusion, reduction of high-flow AVF leads to reverse cardiac remodeling but only in patients with elevated CI. The variability of the response of systemic vascular resistance to AVF flow may explain this observation. Increased CI but not increased AVF flow may better determine candidates for AVF reduction.

Center for Cardiovascular Prevention of the 1st Faculty of Medicine Charles University and Thomayer Hospital Prague Czech Republic

Department of Cardiology Institute for Clinical and Experimental Medicine IKEM Prague Czech Republic

Department of Surgery Faculty Hospital Kralovske Vinohrady 3rd Medical Faculty Charles University Prague Czech Republic

Division of Cardiovascular Diseases Department of Medicine Mayo Clinic Rochester Rochester MN USA

International Clinical Research Center St Anne's University Hospital Brno Czech Republic

Vascular and Transplant Surgery Department Institute for Clinical and Experimental Medicine IKEM Prague Czech Republic

Hypertens Res. 2017 Apr;40(4):411. doi: 10.1038/hr.2016.160. PubMed

Hypertens Res. 2017 Apr;40(4):412. doi: 10.1038/hr.2016.171. PubMed

Zobrazit více v PubMed

Nephrol Dial Transplant. 2001 Feb;16(2):368-72 PubMed

Transplantation. 2002 Jul 15;74(1):73-9 PubMed

Chest. 1987 Dec;92(6):1117-8 PubMed

J Vasc Access. 2008 Apr-Jun;9(2):81-4 PubMed

Heart Fail Rev. 2008 Dec;13(4):379-86 PubMed

QJM. 2009 Apr;102(4):235-41 PubMed

J Vasc Access. 2015 Nov-Dec;16(6):459-66 PubMed

Neth Heart J. 2009 Nov;17(11):429-33 PubMed

Am J Kidney Dis. 2004 May;43(5):e17-22 PubMed

Clin J Am Soc Nephrol. 2008 Mar;3(2):387-91 PubMed

Hypertens Res. 2014 Dec;37(12):1082-7 PubMed

J Vasc Access. 2015 Nov-Dec;16(6):446-53 PubMed

Semin Dial. 2014 Nov-Dec;27(6):633-8 PubMed

Nephrol Dial Transplant. 2012 Oct;27(10):3752-6 PubMed

Hypertens Res. 2014 Feb;37(2):172-8 PubMed

Eur J Vasc Endovasc Surg. 2014 Apr;47(4):444-50 PubMed

Contrib Nephrol. 2015;184:75-86 PubMed

Curr Hypertens Rep. 2015 Aug;17(8):59 PubMed

Eur J Vasc Endovasc Surg. 2010 Jul;40(1):100-6 PubMed

Eur Heart J Cardiovasc Imaging. 2015 Mar;16(3):233-70 PubMed

Am J Kidney Dis. 2006 Jul;48 Suppl 1:S248-73 PubMed

Am J Transplant. 2004 Dec;4(12):2038-44 PubMed

Nephrol Dial Transplant. 2008 Jan;23(1):282-7 PubMed

Nephrol Dial Transplant. 1996 Jan;11(1):94-7 PubMed

Transplantation. 2008 Feb 15;85(3):482-5 PubMed

Pulm Circ. 2015 Jun;5(2):398-406 PubMed

Reply to 'Cardiac remodeling after reduction of high-flow arteriovenous fistulas in end-stage renal disease: methodological issues'