Division of Nephrology, Spedali Civili, and Section of Nephrology, University of Brescia, Brescia, Italy.
Am J Kidney Dis. 2010 Apr;55(4):682-9. doi: 10.1053/j.ajkd.2009.11.008. Epub 2010 Jan 20.
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.
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.
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.
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.
Use of matched rather than randomized controls.
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.
动静脉瘘（AVF）为血液透析提供了有效的血管通路；然而，相关的血液动力学效应可能改变心脏结构和功能。本研究的目的是评估 AVF 关闭对功能和结构超声心动图结果的影响。
前瞻性观察性研究。
在 2003 年至 2006 年间，我们在一家单中心入组了 25 例因其他血管通路用尽而出现动静脉瘘功能障碍的连续血液透析患者，这些患者接受了动静脉瘘关闭术，并转换为隧道式中心静脉导管；同时，我们还招募了 36 例匹配的动静脉瘘功能良好的对照组患者。
动静脉瘘关闭。
在动静脉瘘关闭组中，患者在动静脉瘘关闭前和 6 个月后获得的超声心动图结果发生变化，而对照组在基线和 6 个月后获得的超声心动图结果发生变化。超声心动图测量包括左心室（LV）舒张内径、室间隔厚度、舒张后壁厚度、左心室质量（LVM）、LVM 指数（LVMi）和左心室射血分数（LVEF）。透析方式和方案保持不变。
在动静脉瘘关闭组中，LVM 从 225±55g 降至 206±51g（P<0.001），LVMi 从 135±40g/m2 降至 123±35g/m2（P<0.001）。LV 舒张内径、室间隔厚度和舒张后壁厚度明显减小，而 LVEF 从 56%±7%增加至 59%±6%（P<0.001）。对照组未见明显变化。在动静脉瘘关闭患者中，LV 形态特征显示向心性和离心性肥厚均减少，有利于正常化或向向心性重构模式转变。对照组未见明显变化。
使用匹配而非随机对照。
动静脉瘘的关闭导致 LV 舒张内径、室间隔厚度和舒张后壁厚度显著减小。这与 LVEF 的显著改善、LVM 和 LVMi 的显著降低以及心脏几何形状向正常化的更有利转变相关。
