Ye Wen-ling, Fang Li-gang, Ma Jie, Li Xue-mei
Department of Nephrology, PUMC Hospital, CAMS and PUMC, Beijing, China.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2013 Feb;35(1):95-101. doi: 10.3881/j.issn.1000-503X.2013.01.018.
To evaluate the long-term effects of arteriovenous fistula (AVF) on heamodynamic changes and cardiac structure and function in non-diabetic hemodialysis patients.
Data were collected from 50 non-diabetic hemodialysis patients (aged 18 to 60 years) who had used AVF as the vascular access. AVF flow (Qa), stoke volume (SV), cardiac output (CO), cardiac index (CI), central blood volume (CBV) and peripheral vascular resistance (PR) were measured using the ultrasound dilution technique. Echocardiography was performed in the second day after hemodialysis sessions to evaluate the influence of AVF on the cardiac structure and function.
The cubic polynomial regression model best fit the relationships of Qa with SV, CO, and CI. CO and CI significantly increased and PR reduced when the Qa of AVF was more than 2.0 L/min(all P<0.05), and no statistical difference of CO, CI and PR in groups of Qa between 0.6-2.0 L/min and less than 0.6 L/min(all P>0.05). In different Qa groups, the grades of cardiac function (based on New York Heart Association classification) showed significant difference, among which the cardiac failure was significantly common when Qa >2.0 L/min(both P<0.05). Echocardiography showed the left atrium dimension, thickness of posterior wall and interventricular seprum of left ventricle, left ventricular end-systolic dimension (LVESD) and end-diastolic dimension (LVEDD), venae cava inferior, and pulmonary artery systolic pressure gradually increased when Qa increased, while the ejection fraction and fractional shortening reduced(all P<0.05). Notably, the changes of LVESD, LVEDD, and venae cava inferior with different Qa were statistically significant(all P<0.05).
Long-term AVF remarkably affects the cardiovascular dynamics of non-diabetic hemodialysis patients. A cubic polynomial regression model best fits the relationship of AVF Qa with SV, CO, and CI. The cardiac adaptic changes after long-term AVF include the enlargement of left ventricle and the thickening of ventricular wall. The risk of cardiac failure significantly increases when the Qa of AVF is more than 2.0 L/min with much higher CO and lower PR.
评估动静脉内瘘（AVF）对非糖尿病血液透析患者血流动力学变化以及心脏结构和功能的长期影响。
收集50例使用AVF作为血管通路的非糖尿病血液透析患者（年龄18至60岁）的数据。采用超声稀释技术测量AVF血流量（Qa）、每搏输出量（SV）、心输出量（CO）、心脏指数（CI）、中心血容量（CBV）和外周血管阻力（PR）。在血液透析治疗后第二天进行超声心动图检查，以评估AVF对心脏结构和功能的影响。
三次多项式回归模型最能拟合Qa与SV、CO和CI之间的关系。当AVF的Qa超过2.0 L/min时，CO和CI显著增加，PR降低（所有P<0.05），而在Qa为0.6 - 2.0 L/min组和小于0.6 L/min组之间，CO、CI和PR无统计学差异（所有P>0.05）。在不同Qa组中，心功能分级（基于纽约心脏协会分级）显示出显著差异，其中当Qa>2.0 L/min时，心力衰竭明显更常见（两者P<0.05）。超声心动图显示，随着Qa增加，左心房内径、左心室后壁厚度、室间隔厚度、左心室收缩末期内径（LVESD）和舒张末期内径（LVEDD）、下腔静脉以及肺动脉收缩压逐渐增加，而射血分数和缩短分数降低（所有P<0.05）。值得注意的是，不同Qa时LVESD、LVEDD和下腔静脉的变化具有统计学意义（所有P<0.05）。
长期AVF显著影响非糖尿病血液透析患者的心血管动力学。三次多项式回归模型最能拟合AVF Qa与SV、CO和CI之间的关系。长期AVF后的心脏适应性变化包括左心室扩大和心室壁增厚。当AVF的Qa超过2.0 L/min且CO更高、PR更低时，心力衰竭风险显著增加。
