Long-term Effects of Arteriovenous Fistula Closure on Echocardiographic Functional and Structural Findings in Hemodialysis Patients: A Prospective Study
Long-term Effects of Arteriovenous Fistula Closure on Echocardiographic Functional and Structural Findings in Hemodialysis Patients: A Prospective Study
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DOI：
10.1053/j.ajkd.2009.11.008
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发表时间：
2010-04-01
影响因子：
13.2
通讯作者：
Cancarini, Giovanni
中科院分区：
文献类型：
--
作者：
Movilli, Ezio;Viola, Battista Fabio;Cancarini, Giovanni
背景：动静脉瘘(AVF)为血液透析提供了有效的血管通路，但相关的血流动力学效应可能改变心脏的结构和功能。本研究的目的是评价AVF封堵术对功能和结构超声心动图的影响。研究设计：前瞻性观察研究。背景和对象：2003-2006年间，我们在一个中心连续招募了25名AVF功能不全的血液透析患者，他们因替代血管部位耗尽而接受AVF封堵术并改用隧道中心静脉导管，36名匹配的对照组患者的AVF封堵器功能良好。结果和测量：AVF封堵组患者在AVF封堵术前和6个月后，以及对照组基线和6个月后的超声心动图结果发生变化。超声心动图测量左室舒张内径、室间隔厚度、舒张期后壁厚度、左心室重量(LVm)、左心室重量指数(LVMi)和左心室射血分数(LVEF)。结果：封堵组LVm由225g+/-55降至206g+/-51g(P<；0.001)，LVMi由135g/-40g/m(2)降至123g/m(2)(P<；0.001)。左心室舒张期内径、室间隔厚度、舒张期后壁厚度显著减小，左心室射血分数由56%+/-7%增加至59%+/-6%(P<；0.001)。对照组没有观察到明显的变化。在AVF闭合的患者中，左室形态特征表现为偏心性肥厚和向心性肥厚均减少，有利于正常化或向心性重构。限制：使用配对对照，而不是随机对照。结论：封堵室间隔内径、室间隔厚度和舒张期后壁厚度显著降低。这与LVEF的显著改善、LVm和LVMi的显著下降以及心脏几何结构向正常的更有利的转变有关。AM J Kidney Dis 55：682-689(C)2010年，由国家肾脏基金会公司提供。
Background: The arteriovenous fistula (AVF) provides an effective vascular access for hemodialysis; however, the associated hemodynamic effects may alter cardiac structure and function. The objective of this study is to evaluate the effect of AVF closure on functional and structural echocardiographic findings.Study Design: Prospective observational study.Setting & Participants: In a single center between 2003 and 2006, we enrolled 25 consecutive hemodialysis patients with AVF malfunction who underwent AVF closure and conversion to a tunneled central venous catheter because of exhaustion of alternative vascular sites and 36 matched controls with a well-functioning AVF.Predictor: AVF closure.Outcomes & Measurements: Outcomes were changes in findings on echocardiograms obtained before and 6 months after AVF closure for patients in the AVF-closure group and at baseline and 6 months later for controls. Echocardiographic measurements included left ventricular (LV) internal diastolic diameter, interventricular septum thickness, diastolic posterior wall thickness, LV mass (LVM), LVM index (LVMi), and LV ejection fraction (LVEF). Dialysis modality and scheme were unchanged.Results: In the AVF-closure group, LVM decreased from 225 +/- 55 to 206 +/- 51 g (P < 0.001) and LVMi decreased from 135 +/- 40 to 123 +/- 35 g/m(2) (P < 0.001). LV internal diastolic diameter, interventricular septum thickness, and diastolic posterior wall thickness decreased significantly, whereas LVEF increased from 56% +/- 7% to 59% +/- 6% (P < 0.001). No significant changes were observed in controls. In patients with AVF closure, LV morphologic characteristics showed a decrease in both eccentric and concentric hypertrophy in favor of normalization or a pattern of concentric remodeling. No significant changes were observed in controls.Limitations: Use of matched rather than randomized controls.Conclusions: Closure of an AVF determines a significant decrease in LV internal diastolic diameter, interventricular septum thickness, and diastolic posterior wall thickness. This is associated with significant improvement in LVEF, a significant decrease in LVM and LVMi, and a more favorable shift of cardiac geometry toward normality. Am J Kidney Dis 55:682-689. (C) 2010 by the National Kidney Foundation, Inc.