Hyperdynamic circulation of arteriovenous fistula preconditions the heart and limits infarct size

Mahgoub, Mahmoud A.; Guo, Jian-Hau; Gao, Shujing; Taher, Mohiuddin M.; Salter, David; Wechsler, Andrew S.; Abd‐Elfattah, Anwar S.

doi:10.1016/s0003-4975(99)00277-5

Cited by 9 publications

(5 citation statements)

References 17 publications

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“…who observed that left ventricular performance was improved, and ATP depletion and cardiac infarct size were significantly lower following ischemia and reperfusion injury 8 weeks after AVF creation in a canine model, compared with a sham‐operated group. This observation was thought to occur, in part, by the development of coronary collaterals, which may serve to protect the myocardium during cardiac stress (25).…”

Section: Discussionmentioning

confidence: 99%

Arteriovenous Fistula Use Is Associated with Lower Cardiovascular Mortality Compared with Catheter Use among ESRD Patients

Wasse

Speckman

McClellan

2008

Seminars in Dialysis

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The arteriovenous fistula (AVF) is the recommended form of dialysis vascular access, however, limited studies suggest that AVF creation may result in increased cardiovascular stress and remodeling. To explore the contribution of vascular access type to cardiovascular-related (CV) mortality, we analyzed USRDS Clinical Performance Measures data comprising 4854 patients that initiated dialysis between October 1, 1999-December 31, 2004. CV mortality included death from acute myocardial infarction, atherosclerotic heart disease, cardiomyopathy, arrhythmia, cardiac arrest or stroke. Risk of cardiovascular mortality during a 4-year observation was analyzed by Coxregression methods with adjustments for demographic and co-morbid conditions. AVF use was strongly associated with lower all-cause and CV mortality. After adjustment for covariates, AVF use 90 days after dialysis initiation remained significantly associated with lower cardiovascular mortality [hazard ratio (HR) 0.69, p = 0.0004] compared with catheter use. These findings suggest that vascular access type influences cause-specific mortality beyond that of infection, and support existing guidelines recommending the use of an AVF early in the course of chronic end-stage renal disease therapy.Cardiovascular disease (CVD) is the primary cause of mortality among end-stage renal disease (ESRD) patients (1). Arteriovenous fistulae (AVF) confer protection against sepsis and allcause mortality and are the recommended form of vascular access for hemodialysis patients, compared with arteriovenous grafts (AVG) or central venous catheters (CVC) (2-4). However, it is unknown whether an AVF is associated with increased cardiovascular-related (CV) mortality. Limited reports suggest that AVF creation is associated with hemodynamic changes that impose immediate cardiovascular effects which increase cardiac workload, resulting in left ventricular hypertrophy, the progression of which is associated with CV morbidity, mortality, and all-cause death (5-11).As an increasing proportion of dialysis patients undergo AVF creation, it is critical to better understand the impact of AVF use on CV-related outcomes in order to help guide clinical decision-making prior to dialysis initiation. We have previously described predictors of delayed transition to permanent vascular access among incident hemodialysis patients and extend these observations here to focus on the impact of initial and delayed vascular access type on CV-related mortality (12). We hypothesized that AVF use at dialysis initiation would be associated with increased CV-related mortality, and tested this hypothesis in a contemporary, national cohort of incident hemodialysis patients. Demographic and co-morbid characteristics used in our analysis included age (<54.6, 54.6 to <65.8, 65.8 to <74.5, ≥74.5), gender, race (black, white), pre-ESRD albumin (<3.5 mg/dl, ≥3.5 mg/dl), pre-ESRD hemoglobin (<11 g/dl, ≥11 g/dl), pre-ESRD erythropoietin (yes, no), body mass index (BMI, kg/m 2 ) was classified according to the World Hea...

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Section: Discussionmentioning

confidence: 99%

Arteriovenous Fistula Use Is Associated with Lower Cardiovascular Mortality Compared with Catheter Use among ESRD Patients

Wasse

Speckman

McClellan

2008

Seminars in Dialysis

View full text Add to dashboard Cite

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“…Coronary blood flow was measured using a non-radioactive color microspheres (NuFlow Hydron-Coat™, Irvine, CA) as previously described (11,12) and published online version (E-Methods).…”

Section: Methodsmentioning

confidence: 99%

Myocardial protection in beating heart cardiac surgery: I: Pre- or postconditioning with inhibition of es-ENT1 nucleoside transporter and adenosine deaminase attenuates post-MI reperfusion-mediated ventricular fibrillation and regional contractile dysfunction

Abd‐Elfattah

Aly

Hanan

et al. 2012

The Journal of Thoracic and Cardiovascular Surgery

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Objectives To determine the role of the es-ENT1 nucleoside transporter in post-MI reperfusion injury-mediated ventricular fibrillation (VFib) and regional dysfunction. We used erythro-9 (2-hydroxy-3-nonyl)-adenine (EHNA) and p-nitrobenzylthioinosine (NBMPR) to inhibit both adenosine deamination and transport in a canine model of off pump acute MI. Methods Anesthetized adult dogs (n= 37), instrumented to monitor systolic segmental shortening (SS %) and wall thickening (WT %) using sonomicrometry, underwent 90 minutes of LAD coronary artery occlusion and 120 minutes reperfusion. Myocardial coronary blood flow, ATP pool, infarct size and the incidents of ventricular fibrillation and cardioversions were also measured. Animals received an intravenous infusion of the vehicle (Control) or 100μM of EHNA and 25 μM NBMPR before ischemia (preconditioning, PreC group) or just before reperfusion (postconditioning, PostC group). Results In the control group, ATP depletion was associated with accumulation of more inosine than adenosine during ischemia and washed out during reperfusion. Myocardial adenosine and inosine were the major nucleosides in the PreC- and Post-C groups during ischemia and remained detectable during reperfusion, respectively. In both groups, recovery of systolic SS% and WT%, and reduction in the incidence of VFib (p<0.05 vs. Control group) coincided with retention of myocardial nucleosides. Infarct sizes in the three groups were not significantly different, independent of myocardial blood flow during ischemia. Conclusion PreC-or PostC with EHNA/NBMPR significantly reduced the incidence of ventricular fibrillation and cardioversions and attenuated regional contractile dysfunction mediated by post-MI reperfusion injury and that es-ENT1 plays a major role in these events.

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“…The proangiogenic effect of AVF on the heart is suggested by increased activation of multiple angiogenic factors such as Akt1, Erbb2, HGF, and VEGF; increased regional myocardial blood flow was observed in dogs with AVF compared with those without, and was postulated as a mechanism by which AVF decreased the size of induced myocardial infarctions. 92 Another potential mechanism of cardioprotection is the upregulation of proproliferative and prosurvival molecules ( Fig 6 ) that might increase cellular tolerance to ischemia or injury. These results suggest that AVF-induced cardiac remodeling might not be as deleterious as previously thought and might even confer some benefit.…”

Section: Discussionmentioning

confidence: 99%

Arteriovenous fistula-induced cardiac remodeling shows cardioprotective features in mice

Lee

Thorn

Guerrera

et al. 2021

JVS-Vascular Science

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Objective Arteriovenous fistulae (AVF) placed for hemodialysis have high flow rates that can stimulate left ventricular (LV) hypertrophy. LV hypertrophy generally portends poor cardiac outcomes, yet clinical studies point to superior cardiac-specific outcomes for patients with AVF when compared with other dialysis modalities. We hypothesize that AVF induce physiologic cardiac hypertrophy with cardioprotective features. Methods We treated 9- to 11-week-old C57Bl/6 male and female mice with sham laparotomy or an aortocaval fistula via a 25G needle. Cardiac chamber size and function were assessed with serial echocardiography, and cardiac computed tomography angiography. Hearts were harvested at 5 weeks postoperatively, and the collagen content was assessed with Masson's trichrome. Bulk messenger RNA sequencing was performed from LV of sham and AVF mice at 10 days. Differentially expressed genes were analyzed using Ingenuity Pathway Analysis (Qiagen) to identify affected pathways and predict downstream biological effects. Results Mice with AVF had similar body weight and wet lung mass, but increased cardiac mass compared with sham-operated mice. AVF increased cardiac output while preserving LV systolic and diastolic function, as well as indices of right heart function; all four cardiac chambers were enlarged, with a slight decrement in the relative LV wall thickness. Histology showed preserved collagen density within each of the four chambers without areas of fibrosis. RNA sequencing captured 19 384 genes, of which 857 were significantly differentially expressed, including transcripts from extracellular matrix-related genes, ion channels, metabolism, and cardiac fetal genes. The top upstream regulatory molecules predicted include activation of angiogenic (Vegf, Akt1), procardiomyocyte survival (Hgf, Foxm1, Erbb2, Lin9, Areg), and inflammation-related (CSF2, Tgfb1, TNF, Ifng, Ccr2, IL6) genes, as well as the inactivation of cardiomyocyte antiproliferative factors (Cdkn1a, FoxO3, α-catenin). The predicted downstream effects include a decrease in heart damage, and increased arrhythmia, angiogenesis, and cardiogenesis. There were no significant sex-dependent differences in the AVF-stimulated cardiac adaptation. Conclusions AVF stimulate adaptive cardiac hypertrophy in wild-type mice without heart failure or pathologic fibrosis. Transcriptional correlates suggest AVF-induced cardiac remodeling has some cardioprotective, although also arrhythmogenic features. (JVS–Vascular Science 2021;2:110-28.) Clinical Relevance Arteriovenous fistulae (AVF) are commonly used as access for hemodialysis in patients with end-stage renal disease. AVF induce a high-output state that is associated with long-term structural cardiac remodeling, including left ventricle hypertrophy, but this element has uncertain clinical significance. Although left ventricle hypertrophy has traditionally been associated with an in...

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Hyperdynamic circulation of arteriovenous fistula preconditions the heart and limits infarct size

Cited by 9 publications

References 17 publications

Arteriovenous Fistula Use Is Associated with Lower Cardiovascular Mortality Compared with Catheter Use among ESRD Patients

Arteriovenous Fistula Use Is Associated with Lower Cardiovascular Mortality Compared with Catheter Use among ESRD Patients

Myocardial protection in beating heart cardiac surgery: I: Pre- or postconditioning with inhibition of es-ENT1 nucleoside transporter and adenosine deaminase attenuates post-MI reperfusion-mediated ventricular fibrillation and regional contractile dysfunction

Arteriovenous fistula-induced cardiac remodeling shows cardioprotective features in mice

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