Pathophysiology of biventricular dysfunction during hemodialysis: Emerging concepts

Paneni, Francesco; Gregori, Mario; Pignatelli, Giulia; Ciavarella, Giuseppino Massimo; Punzo, Giorgio; Biase, Luciano De; Menè, Paolo; Volpe, Massimo

doi:10.1016/j.ijcard.2011.12.074

Cited by 9 publications

(8 citation statements)

References 19 publications

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“…The studies from Paneni et al have suggested that chronic overload imposed by AVF could negatively affect RV function in HD patients, when compared with peritoneal dialysis patients and controls. [3][4][5] Similarly Di Lullo et al 17 have found flow overload in the right sections of HD patients, with an AVF similar to those with a central vein catheter. From our results, it seems therefore confirmed the relationship between flow overload and RV dysfunction.…”

Section: Discussionmentioning

confidence: 90%

“…The arteriovenous fistula (AVF) itself induces a volume/pressure overload which impairs left and right ventricular function, increases pulmonary pressures and determines left ventricular hypertrophy. [3][4][5][6][7] In presence of high-flow vascular access (Qa > 1.5 L/min/1.73 m 2 ) and increased cardio-pulmonary recirculation (CPR = Qa/CO > 20%), high-output heart failure may finally occur and a flow reduction of AVF is suggested. 8 A 2016 meta-analysis of AVF closure in transplant patients has shown a reduction in left ventricular mass after a follow-up period ranging from 6 to 21 months.…”

Section: Introductionmentioning

confidence: 99%

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Early echocardiographic modifications after flow reduction by proximal radial artery ligation in patients with high-output heart failure due to high-flow forearm arteriovenous fistula

Maresca¹,

Filice

Orlando

et al. 2020

J Vasc Access

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Background: Arteriovenous fistula (AVF) for haemodialysis (HD) induces a volume/pressure overload which impairs bi-ventricular function and increases systolic pulmonary arterial pressure (PAPS) and left ventricular mass (LVM). In the presence of high blood flow (Qa) AVF (> 1.5 L/min/1.73 m2) and cardio-pulmonary recirculation (>20%), high-output congestive heart failure (CHF) may occur and AVF flow reduction is recommended. Proximal Radial Artery Ligation (PRAL) is an effective technique for distal radio-cephalic (RC) AVF flow reduction. Methods: we evaluated six HD and four transplant patients with high-flow RC AVF and symptoms of CHF who underwent PRAL. We compared echocardiographic (ECHO) findings before (T0) and 1 and 6 months (T1,T6) after PRAL. Preoperative ECHO was performed before (T0b) and after AVF anastomosis manual compression (T0c). Results: At T1 AVF flow reduction rate was 58.4% ± 13% and 80% of patients reported improved CHF symptoms. ECHO data showed an improvement of tricuspid annular plane systolic excursion (TAPSE) at T1 (p = 0.03) and a reduction of PAPS at T6 (p = 0.04). TAPSE improved after AVF anastomosis compression during preoperative ECHO (p = 0.03). Delta of TAPSE at the dynamic manoeuvre at T0 directly correlated with early (1 month after PRAL, p = 0.01) and late (6 months after PRAL, p = 0.04) deltas of TAPSE. Conclusions: AVF flow reduction after PRAL induces immediate regression of CHF symptoms, early improvement of TAPSE and late improvement of PAPS, suggesting a prevalent right sections involvement in CHF. Preoperative TAPSE modification after AVF anastomosis compression could represent a useful evaluation tool to determine which patients would benefit of PRAL.

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Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Early echocardiographic modifications after flow reduction by proximal radial artery ligation in patients with high-output heart failure due to high-flow forearm arteriovenous fistula

Maresca¹,

Filice

Orlando

et al. 2020

J Vasc Access

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“…18 More importantly, MPI offers a simultaneous evaluation of systolic and diastolic function because in its formula, isovolumic relaxation and contraction times, as well as the ventricular ET, are included. 15,25 In our study, MPI values 40.56 (RV) and 40.60 (LV) were considered abnormal according to variable distribution in a control group of healthy subjects. Although our study did not assess the prognostic impact of such MPI cutoffs, similar values were powerful predictors of cardiovascular mortality in patients with preserved systolic function.…”

Section: Discussionmentioning

confidence: 99%

Do diabetes, metabolic syndrome or their association equally affect biventricular function? A tissue Doppler study

Paneni

Gregori²,

Palano³

et al. 2012

Hypertens Res

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Metabolic syndrome (MetS) and type 2 diabetes (T2DM) have been associated with an impairment of left (LV) and right ventricular (RV) function as well as an increased risk of heart failure (HF). However, it remains unclear whether these clinical entities or their associations promote a similar derangement of biventricular function. Overall, 345 patients without overt cardiovascular disease consecutively underwent routine blood chemistry including high-sensitivity C reactive protein (hs-CRP) and echocardiographical examination with conventional and tissue Doppler imaging (TDI) of both ventricles. According to the ATP III criteria and fasting glucose levels, the study population was stratified into four groups: (1) healthy controls (n=120); (2) MetS without T2DM (n=84); (3) T2DM without MetS (n=49); and (4) MetS+T2DM (n=92). The Myocardial performance index (MPI) of the RV and LV was obtained with a multi-segmental approach using TDI. Patients with MetS and T2DM exhibited a similar impairment of biventricular function compared with healthy controls, whereas a further decline was observed in patients having both MetS and T2DM. In addition to MetS markers, hs-CRP exhibited the strongest association with the MPI of both ventricles. Regression analyses indicated that individual MetS markers were inferior to MetS in identifying subtle cardiac dysfunction. Independent associations of MetS and T2DM with biventricular dysfunction were comparable, and the coexistence of MetS and T2DM exhibited the highest risk for biventricular dysfunction. Our findings emphasize the importance of MetS as an equivalent of T2DM and support a synergic effect of these clinical conditions on cardiac organ damage requiring more aggressive therapeutic strategies to prevent HF.

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“…End-diastolic and end-systolic left ventricular internal diameters (LVEDd, LVEDs), end-diastolic interventricular septum and infero-lateral wall-thickness (ILWd) were calculated from five consecutive cardiac cycles according to the current guidelines [11]. Left ventricular (LV) mass was calculated according to the Devereux formula [12], and normalized for body surface area (LVMi).…”

Section: Participants and Methodsmentioning

confidence: 99%

“…The latter represent an appealing option, as a relatively cheap, completely harmless method able to describe not only volume status [7][8][9][10] but to picture the spectrum of ESRD cardiomiopathy as well [11][12].…”

Section: Introductionmentioning

confidence: 99%

Non Invasive Evaluation of Cardiac Hemodynamics in End Stage Renal Disease (ESRD)

Milan

Avenatti

Valle

et al. 2014

High Blood Press Cardiovasc Prev

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Objective: Volume overload is typical of haemodialysis patients; correct volume status evaluation is crucial in achieving blood pressure homeostasis, hypertension management and good treatment planning. This study evaluates the effect of acute volume depletion on ultrasonographic parameters and suggests two of them as able to predict patients volume overload. and LV end-diastolic diameter (LVEDd) indexed to height 2.7(LVEDdi) were able to predict volume overload: cut off values of respectively 13.5 mm/m 2.7 for LVEDdi and 173 cJ for SW were able to predict with a specificity of 100% the presence of a volemic overload of at least 4%. Patients and InterventionConclusions: Blood pressure, cardiac morphology and function are significantly modified by acute volume depletion and such variations are strictly interrelated. SW and LVEDd/height 2.7 may identify ESRD patients carrying an higher volume load.

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Pathophysiology of biventricular dysfunction during hemodialysis: Emerging concepts

Cited by 9 publications

References 19 publications

Early echocardiographic modifications after flow reduction by proximal radial artery ligation in patients with high-output heart failure due to high-flow forearm arteriovenous fistula

Early echocardiographic modifications after flow reduction by proximal radial artery ligation in patients with high-output heart failure due to high-flow forearm arteriovenous fistula

Do diabetes, metabolic syndrome or their association equally affect biventricular function? A tissue Doppler study

Non Invasive Evaluation of Cardiac Hemodynamics in End Stage Renal Disease (ESRD)

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