Haider Muhammad Zaryab, Mule Ranjith, Anees Ur Rehman Muhammad, Ul Ain Qurat, Jamil Muhammad Irfan, Mufti Tayyaba Arooj, Butt Muhammad Ahsan, Anam Fnu, Shahzeen Fnu
Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, PAK.
Acute Internal Medicine, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, GBR.
Cureus. 2025 Aug 9;17(8):e89693. doi: 10.7759/cureus.89693. eCollection 2025 Aug.
Arteriovenous fistula (AVF) creation remains the preferred vascular access for hemodialysis in patients with advanced chronic kidney disease (CKD). However, the hemodynamic burden imposed by an AVF may lead to progressive cardiac remodeling, with implications for long-term cardiovascular morbidity. This study aimed to evaluate structural and functional cardiac changes following AVF creation in stage 4 and 5 CKD patients over a six-month follow-up using serial echocardiography.
This prospective study initially included 150 patients; however, 105 patients with complete data were analyzed at the six-month follow-up. Transthoracic echocardiography was performed at three time points: before AVF creation, at three months, and six months post-creation.
At three months, transient improvements were noted in the left ventricular ejection fraction (53.16 ± 5.21% to 56.23 ± 4.85%, p<0.001), global longitudinal strain (GLS) (-15.21 ± 0.91% to -15.38 ± 0.89%, p<0.001), and diastolic indices. However, by six months, progressive cardiac remodeling was evident with significant increases in the left ventricular mass index (+20.63 ± 6.04 g/m², p<0.001), left ventricular end-diastolic diameter and left ventricular end-systolic diameter, and left atrial volume index (+7.50 ± 1.23 mL/m², p<0.001). Diastolic function deteriorated (early-to-atrial filling velocity ratio (E/A) and early diastolic to mitral annular velocity ratio (E/e'), p<0.001), pulmonary artery systolic pressure increased by +9.90 ± 1.42 mmHg, tricuspid annular plane systolic excursion declined (-2.07 ± 0.44 mm), and tricuspid regurgitation velocity rose (+0.38 ± 0.14 m/s). GLS showed a subclinical decline (-0.38 ± 0.11%, p<0.001).
AVF creation results in a biphasic cardiac response with early adaptive changes followed by significant structural and functional deterioration by six months.
动静脉内瘘（AVF）的建立仍是晚期慢性肾脏病（CKD）患者血液透析首选的血管通路。然而，AVF带来的血流动力学负担可能导致心脏进行性重塑，影响长期心血管疾病发病率。本研究旨在通过连续超声心动图评估4期和5期CKD患者在建立AVF后6个月内心脏结构和功能的变化。
本前瞻性研究最初纳入150例患者；然而，在6个月随访时对105例有完整数据的患者进行了分析。在三个时间点进行经胸超声心动图检查：建立AVF前、建立后3个月和6个月。
在3个月时，左心室射血分数（从53.16±5.21%提高到56.23±4.85%，p<0.001）、整体纵向应变（GLS，从-15.21±0.91%提高到-15.38±0.89%，p<0.001）和舒张指标有短暂改善。然而，到6个月时，明显出现了进行性心脏重塑，左心室质量指数显著增加（+20.63±6.04g/m²，p<0.001），左心室舒张末期直径、左心室收缩末期直径以及左心房容积指数增加（+7.50±1.23mL/m²，p<0.001）。舒张功能恶化（舒张早期与心房充盈速度比值（E/A）以及舒张早期与二尖瓣环速度比值（E/e'），p<0.001），肺动脉收缩压升高+9.90±1.42mmHg，三尖瓣环平面收缩期位移下降（-2.07±0.44mm），三尖瓣反流速度升高（+0.38±0.14m/s）。GLS出现亚临床下降（-0.38±0.11%，p<0.001）。
建立AVF导致心脏出现双相反应，早期有适应性变化，随后到6个月时出现明显的结构和功能恶化。
