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The effect of high‐flow arteriovenous fistulas on systemic haemodynamics and brain oxygenation
AIMS: High‐flow arteriovenous fistula (AVF) for haemodialysis leads to profound haemodynamic changes and sometimes to heart failure (HF). Cardiac output (CO) is divided between the AVF and body tissues. The term effective CO (COef) represents the difference between CO and AVF flow volume (Qa) and be...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8120398/ https://www.ncbi.nlm.nih.gov/pubmed/33755355 http://dx.doi.org/10.1002/ehf2.13305 |
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author | Malik, Jan Valerianova, Anna Tuka, Vladimir Trachta, Pavel Bednarova, Vladimira Hruskova, Zdenka Slavikova, Marcela Rosner, Mitchell H. Tesar, Vladimir |
author_facet | Malik, Jan Valerianova, Anna Tuka, Vladimir Trachta, Pavel Bednarova, Vladimira Hruskova, Zdenka Slavikova, Marcela Rosner, Mitchell H. Tesar, Vladimir |
author_sort | Malik, Jan |
collection | PubMed |
description | AIMS: High‐flow arteriovenous fistula (AVF) for haemodialysis leads to profound haemodynamic changes and sometimes to heart failure (HF). Cardiac output (CO) is divided between the AVF and body tissues. The term effective CO (COef) represents the difference between CO and AVF flow volume (Qa) and better characterizes the altered haemodynamics that may result in organ hypoxia. We investigated the effects of Qa reduction on systemic haemodynamics and on brain oxygenation. METHODS AND RESULTS: This is a single‐centre interventional study. Twenty‐six patients on chronic haemodialysis with high Qa (>1500 mL/min) were indicated for surgical Qa reduction for HF symptoms and/or signs of structural heart disease on echocardiography. The included patients underwent three sets of examinations: at 4 months and then 2 days prior and 6 weeks post‐surgical procedure. Clinical status, echocardiographical haemodynamic assessment, Qa, and brain oximetry were recorded. All parameters remained stable from selection to inclusion. After the procedure, Qa decreased from 3.0 ± 1.4 to 1.3 ± 0.5 L/min, P < 0.00001, CO from 7.8 ± 1.9 to 6.6 ± 1.5 L/min, P = 0.0002, but COef increased from 4.6 ± 1.4 to 5.3 ± 1.4 L/min, P = 0.036. Brain tissue oxygen saturation increased from 56 ± 11% to 60 ± 9%, P = 0.001. CONCLUSIONS: Qa reduction led to increased COef. This was explained by a decreased proportion of CO running through the AVF in patients with Qa > 2.0 L/min. These observations were mirrored by higher brain oxygenation and might explain HF symptoms and improved haemodynamics even in asymptomatic high Qa patients. |
format | Online Article Text |
id | pubmed-8120398 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-81203982021-05-21 The effect of high‐flow arteriovenous fistulas on systemic haemodynamics and brain oxygenation Malik, Jan Valerianova, Anna Tuka, Vladimir Trachta, Pavel Bednarova, Vladimira Hruskova, Zdenka Slavikova, Marcela Rosner, Mitchell H. Tesar, Vladimir ESC Heart Fail Original Research Articles AIMS: High‐flow arteriovenous fistula (AVF) for haemodialysis leads to profound haemodynamic changes and sometimes to heart failure (HF). Cardiac output (CO) is divided between the AVF and body tissues. The term effective CO (COef) represents the difference between CO and AVF flow volume (Qa) and better characterizes the altered haemodynamics that may result in organ hypoxia. We investigated the effects of Qa reduction on systemic haemodynamics and on brain oxygenation. METHODS AND RESULTS: This is a single‐centre interventional study. Twenty‐six patients on chronic haemodialysis with high Qa (>1500 mL/min) were indicated for surgical Qa reduction for HF symptoms and/or signs of structural heart disease on echocardiography. The included patients underwent three sets of examinations: at 4 months and then 2 days prior and 6 weeks post‐surgical procedure. Clinical status, echocardiographical haemodynamic assessment, Qa, and brain oximetry were recorded. All parameters remained stable from selection to inclusion. After the procedure, Qa decreased from 3.0 ± 1.4 to 1.3 ± 0.5 L/min, P < 0.00001, CO from 7.8 ± 1.9 to 6.6 ± 1.5 L/min, P = 0.0002, but COef increased from 4.6 ± 1.4 to 5.3 ± 1.4 L/min, P = 0.036. Brain tissue oxygen saturation increased from 56 ± 11% to 60 ± 9%, P = 0.001. CONCLUSIONS: Qa reduction led to increased COef. This was explained by a decreased proportion of CO running through the AVF in patients with Qa > 2.0 L/min. These observations were mirrored by higher brain oxygenation and might explain HF symptoms and improved haemodynamics even in asymptomatic high Qa patients. John Wiley and Sons Inc. 2021-03-23 /pmc/articles/PMC8120398/ /pubmed/33755355 http://dx.doi.org/10.1002/ehf2.13305 Text en © 2021 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. |
spellingShingle | Original Research Articles Malik, Jan Valerianova, Anna Tuka, Vladimir Trachta, Pavel Bednarova, Vladimira Hruskova, Zdenka Slavikova, Marcela Rosner, Mitchell H. Tesar, Vladimir The effect of high‐flow arteriovenous fistulas on systemic haemodynamics and brain oxygenation |
title | The effect of high‐flow arteriovenous fistulas on systemic haemodynamics and brain oxygenation |
title_full | The effect of high‐flow arteriovenous fistulas on systemic haemodynamics and brain oxygenation |
title_fullStr | The effect of high‐flow arteriovenous fistulas on systemic haemodynamics and brain oxygenation |
title_full_unstemmed | The effect of high‐flow arteriovenous fistulas on systemic haemodynamics and brain oxygenation |
title_short | The effect of high‐flow arteriovenous fistulas on systemic haemodynamics and brain oxygenation |
title_sort | effect of high‐flow arteriovenous fistulas on systemic haemodynamics and brain oxygenation |
topic | Original Research Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8120398/ https://www.ncbi.nlm.nih.gov/pubmed/33755355 http://dx.doi.org/10.1002/ehf2.13305 |
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