心血管疾病是终末期肾病患者发病和死亡的主要原因。动静脉瘘(AVF),血液透析血管通路的黄金标准,已知改变心脏形态和循环血液动力学。我们提出了一个前瞻性病例系列的患者在创建AVF后,探索心脏形态变化的时间表,并详细考虑临床医生。
■在上臂AVF产生和血液透析开始之前,2010年在多个中心招募患者。在AVF创建之前,在摄入时拍摄心血管磁共振图像,6个月随访,和12个月的随访。图像分割用于测量左心室容积和质量,左心房容积,和射血分数。
■8名患者符合资格标准。所有8名患者的左心室质量都比招募组净增加,平均增加9.16g(+2.96至+42.66g)。五名参与者的射血分数净下降,射血分数的平均变化为-5.4%(-21%至5%)。经目视检查,射血分数下降最大的患者的心室明显肥大和扩张。左心房容积变化不同,在五名参与者中减少,同时增加三个参与者。6个月随访时出现形态学变化,即使是在整个6个月期间未保持AVF通畅的患者.
■纳入本前瞻性病例系列的所有患者左心室质量均增加,对射血分数和左心房容积的影响具有变异性。由于左心室质量是发病率和死亡率的独立预测因子,有必要进一步研究以确定终末期肾病和肾移植人群中适当的血管通路管理.
UNASSIGNED: Cardiovascular disease is a major cause of morbidity and mortality in patients with end-stage kidney disease. Arterio-venous fistulas (AVF), the gold standard for hemodialysis vascular access, are known to alter cardiac morphology and circulatory hemodynamics. We present a prospective
case series of patients after creation of an AVF, explore the timeline for changes in their cardiac morphology, and detail considerations for clinicians.
UNASSIGNED: Patients were recruited in 2010 at multiple centers immediately prior to the creation of an upper-arm AVF and the initiation of hemodialysis. Cardiovascular magnetic resonance images were taken at intake before the creation of the AVF, 6-month follow-up, and 12-month follow-up. Image segmentation was used to measure left ventricular volume and mass, left atrial volume, and ejection fraction.
UNASSIGNED: Eight patients met eligibility criteria. All eight patients had a net increase in left ventricular mass over enrollment, with a mean increase of 9.16 g (+2.96 to +42.66 g). Five participants had a net decrease in ejection fraction, with a mean change in ejection fraction of -5.4% (-21% to +5%). Upon visual inspection the patients with the largest ejection fraction decrease had noticeably hypertrophic and dilated ventricles. Left atrial volume change was varied, decreasing in five participants, while increasing in three participants. Changes in morphology were present at 6-month follow-up, even in patients who did not maintain AVF patency for the entirety of the 6-month period.
UNASSIGNED: All patients included in this prospective
case series had increases in left ventricular mass, with variability in the effects on the ejection fraction and left atrial volume. As left ventricular mass is an independent predictor of morbidity and mortality, further research to determine appropriate vascular access management in both end-stage kidney disease and kidney transplant populations is warranted.