Effects of the creation of arteriovenous fistula for hemodialysis on cardiac function and natriuretic peptide levels in CRF
Effects of the creation of arteriovenous fistula for hemodialysis on cardiac function and natriuretic peptide levels in CRF
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DOI：
10.1053/ajkd.2002.36329
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发表时间：
2002-11-01
影响因子：
13.2
通讯作者：
Kawano, Y
中科院分区：
文献类型：
--
作者：
Iwashima, Y;Horio, T;Kawano, Y
背景：心力衰竭有时是由于血液透析血管通路的形成引起的。然而，动静脉瘘对心功能的影响尚未完全阐明。本研究探讨了房室瘘手术后心功能和激素水平的一系列变化。方法：16例慢性肾衰竭患者行房室瘘手术前、术后3、7、14天超声心动图检查。分别于术前、术后1、3、6、10、14 d测定血浆心房钠肽（ANP）和脑钠肽（BNP）浓度。结果：房室瘘的产生导致左室（LV）舒张末期内径（+4%）、分数缩短（+8%）和心输出量（CO; +15%）显著升高。多普勒超声心动图测量左室流入速度，舒张早期充盈波减速时间缩短（-12%），舒张早期峰值速度与心房充盈的比值（E-A比）增加（+18%）。左室流入时间和左室舒张末压指标——心房收缩时肺静脉流量的差异在术后第14天显著缩短（-37%）。也就是说，房室瘘的形成导致左室舒张功能障碍，形成限制性充盈模式。术后ANP和BNP水平均升高，10 d后达到最大升高百分比（ANP +48%, BNP +68%）。在心功能与激素反应的关系中，CO的升高与ANP水平升高相关（r = 0.61; P = 0.01），而与BNP水平无关。相反，E-A比值的升高仅与BNP水平升高相关（r = 0.60; P = 0.01）。结论：我们的观察表明，房室瘘的形成对心脏收缩和舒张性能有显著影响，ANP的释放是由容量负荷诱导的，而BNP的释放是由左室舒张功能障碍刺激的。[J]肾脏杂志，40:974-982。(C) 2002年由国家肾脏基金会，Inc。
Background: Cardiac failure occasionally is caused by the creation of vascular access for hemodialysis. However, the influence of an arteriovenous (AV) fistula on cardiac function has not been fully elucidated. The present study investigated serial changes in cardiac function and hormonal levels after the AV fistula operation.Methods: Sixteen patients with chronic renal failure underwent echocardiographic studies before and 3, 7, and 14 days after the AV fistula operation. Plasma atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) concentrations were measured before and 1, 3, 6, 10, and 14 days after the operation.Results: Creation of an AV fistula produced significant elevations in left ventricular (LV) end-diastolic diameter (+4%), fractional shortening (+8%), and cardiac output (CO; +15%). In LV inflow velocities measured by Doppler echocardiography, deceleration time of the early diastolic filling wave shortened (-12%) and the ratio of the peak velocity of early diastolic to atrial filling (E-A ratio) increased (+18%). The difference in duration of LV inflow and pulmonary venous flow at atrial contraction, a marker of LV end-diastolic pressure, significantly shortened day 14 after the operation (-37%). That is, creation of an AV fistula induced LV diastolic dysfunction toward a restrictive filling pattern. Both ANP and BNP levels increased after the operation, and maximal percentages of increase were observed after 10 days (ANP, +48%; BNP, +68%). In the relationship between cardiac function and hormonal response, the increase in CO was associated with elevation of ANP levels (r = 0.61; P = 0.01), but not BNP levels. Conversely, the increase in E-A ratio correlated only with BNP level elevation (r = 0.60; P = 0.01).Conclusion: Our observations indicate that creation of an AV fistula has significant effects on cardiac systolic and diastolic performance, and ANP release is induced by volume loading, but BNP release is stimulated by LV diastolic dysfunction. Am J Kidney Dis 40:974-982. (C) 2002 by the National Kidney Foundation, Inc.