2022
DOI: 10.1177/11297298211066766
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Cardiac implications of upper-arm arteriovenous fistulas: A case series

Abstract: Background: 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. Methods: Patients were recruited in 2010 at multiple centers im… Show more

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Cited by 3 publications
(5 citation statements)
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“…At the follow-up visit, the patients had a mean Qa value of 1158 mL/min, and significantly higher left ventricular mass and dilatation of all cardiac chambers. A recent study reported similar results [8].…”
Section: Safe Upper Limit Of Qasupporting
confidence: 68%
“…At the follow-up visit, the patients had a mean Qa value of 1158 mL/min, and significantly higher left ventricular mass and dilatation of all cardiac chambers. A recent study reported similar results [8].…”
Section: Safe Upper Limit Of Qasupporting
confidence: 68%
“…Structural heart disease such as increased LVM or cardiac fibrosis appear to be an important cause of increased morbidity and mortality in HD population, but EF monitoring is not sufficient for detecting these changes ( 1 , 17 , 23 , 26 ). Myocardial fibrosis is an important part of cardiac remodeling that leads to HF, in particular HF with a preserved EF (HFpEF).…”
Section: Discussionmentioning
confidence: 99%
“…The creation of a new functioning arteriovenous fistula (AVF) in HD patients causes an acute decrease in systemic vascular resistance and a secondary increase in cardiac output (CO) ( 13 15 ). The increased CO and greater venous return lead to increased left ventricular (LV) pressure and higher LV mass causing LVH ( 16 , 17 ). In general, these hemodynamic changes are clinically insignificant, however, in certain cases (such as high-flow AVF), they can cause new or worsening heart failure (HF), so-called high-output HF ( 18 , 19 ).…”
Section: Introductionmentioning
confidence: 99%
“…Finally, we feel that Pucchio et al 1 did a great job by measuring cardiac alterations due to AVF formation. We believe, however, that the impact of AVF creation on clinical and mortality outcomes remains to be proven.…”
mentioning
confidence: 96%
“…We read with considerable interest the recent Research Article by Pucchio et al, 1 presenting a prospective case series of cardiac imaging 12-months following upper-arm arterio-venous fistula (AVF) creation, demonstrating adverse changes in patients’ cardiac morphology—increases in left ventricular mass (LVM), changes of the ejection fraction (EF), and left atrial volume (LAV). Because of a scarcity of such research, it is a great essay presenting the timeline for cardiac involvement due to hemodynamic changes as a result of AVF formation.…”
mentioning
confidence: 99%