Long-term cardiovascular changes following creation of arteriovenous fistula in patients with end stage renal disease
Jazyk angličtina Země Velká Británie, Anglie Médium print
Typ dokumentu časopisecké články
PubMed
28329100
DOI
10.1093/eurheartj/ehx045
PII: 3062803
Knihovny.cz E-zdroje
- Klíčová slova
- Arteriovenous fistula, Dialysis, Heart failure, Kidney,
- MeSH
- arteriovenózní zkrat škodlivé účinky MeSH
- chronické selhání ledvin patofyziologie terapie MeSH
- dialýza ledvin MeSH
- echokardiografie MeSH
- funkce pravé komory srdeční fyziologie MeSH
- kardiorenální syndrom etiologie patofyziologie MeSH
- krevní tlak fyziologie MeSH
- lidé MeSH
- minutový srdeční výdej fyziologie MeSH
- objem plazmy fyziologie MeSH
- pooperační komplikace etiologie patofyziologie MeSH
- remodelace komor fyziologie MeSH
- retrospektivní studie MeSH
- senioři MeSH
- tělesná hmotnost fyziologie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články 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
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