Song Wenhui, Wu Lizhou, Sun Chong, Kong Xianglei, Wang Haiyan
Department of Medical Ultrasound, Shandong Medicine and Health Key Laboratory of Abdominal Medical Imaging, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China.
Department of Nephrology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Nephrology, Jinan, China.
Front Cardiovasc Med. 2024 Apr 12;11:1386304. doi: 10.3389/fcvm.2024.1386304. eCollection 2024.
End-stage renal disease (ESRD) patients have a high potential cardiovascular burden, and cardiovascular disease (CVD) is the leading cause of death in maintenance haemodialysis (MHD) patients. Arteriovenous fistula (AVF) is the preferred vascular access for MHD patients, but AVF significantly affects the haemodynamics of the cardiovascular system, leading to or exacerbating CVD, including atrial fibrillation (AF). This study aimed to evaluate the impact of AVF on cardiac function, especially of the left atrium (LA), in patients with ESRD and to further explore the relationship between AVF establishment and the occurrence of AF.
We selected 1,107 ESRD patients on haemodialysis using AVF and 550 patients with tunneled-cuffed catheters (TCC) admitted between January 2016 and December 2022 for follow-up to compare the rate of AF between the two groups. A total of 153 patients in the AVF group with complete information (clinical data, echocardiographic and biochemical indices, and other data) were enrolled and retrospectively analysed for risk factors for the development of AF and were followed up for adverse clinical outcomes (including all-cause death, cardiac death, readmission due to heart failure, and stroke).
The incidence of new-onset AF was higher in the AVF group than the TCC group after dialysis access was established (16.30% vs. 5.08%, < 0.001). Echocardiography showed that the LA anteroposterior diameter increased ( < 0.001) and the incidence of AF increased from 11.76% to 26.14% ( = 0.001) after AVF establishment. Multivariate logistic regression analysis showed that age and LA enlargement were independent risk factors for new-onset AF after AVF establishment ( < 0.05). Adverse clinical outcomes were more common in patients with AF than in patients without AF ( < 0.001). Multivariate Cox risk regression analysis suggested that new-onset AF (HR = 4.08, 95% CI: 2.00-8.34, < 0.001) and left ventricular systolic dysfunction (HR = 2.42, 95% CI: 1.20-4.88, = 0.01) after AVF establishment were independent risk factors for adverse clinical outcomes.
LA enlargement after AVF establishment is associated with a significant increase in the incidence of AF, in addition, AF which is as an important influential factor in patients with MHD combined other systemic diseases might increase adverse clinical events.
(NCT06199609).
终末期肾病（ESRD）患者具有较高的潜在心血管负担，心血管疾病（CVD）是维持性血液透析（MHD）患者的主要死亡原因。动静脉内瘘（AVF）是MHD患者首选的血管通路，但AVF会显著影响心血管系统的血流动力学，导致或加重CVD，包括心房颤动（AF）。本研究旨在评估AVF对ESRD患者心脏功能的影响，尤其是对左心房（LA）的影响，并进一步探讨AVF建立与AF发生之间的关系。
我们选取了2016年1月至2022年12月期间接受AVF血液透析的1107例ESRD患者和550例带隧道带涤纶套中心静脉导管（TCC）患者进行随访，比较两组AF发生率。AVF组共有153例具备完整信息（临床资料、超声心动图及生化指标等数据）的患者纳入研究，对AF发生的危险因素进行回顾性分析，并随访不良临床结局（包括全因死亡、心源性死亡、因心力衰竭再次入院及卒中）。
建立透析通路后，AVF组新发AF的发生率高于TCC组（16.30%对5.08%，P<0.001）。超声心动图显示，建立AVF后LA前后径增加（P<0.001），AF发生率从11.76%升至26.14%（P=0.001）。多因素logistic回归分析显示，年龄和LA扩大是建立AVF后新发AF的独立危险因素（P<0.05）。AF患者的不良临床结局比无AF患者更常见（P<0.001）。多因素Cox风险回归分析提示，建立AVF后新发AF（HR=4.08，95%CI：2.00-8.34，P<0.001）和左心室收缩功能障碍（HR=2.42，95%CI：1.20-4.88，P=0.01）是不良临床结局的独立危险因素。
建立AVF后LA扩大与AF发生率显著增加相关，此外，AF作为MHD合并其他全身性疾病患者的重要影响因素，可能增加不良临床事件。
（NCT06199609）
