Flow-driven left ventricular remodelling in long-term haemodialysis: a multicenter model of arteriovenous access-induced cardiac load

Figures

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  Figure 1.. Study flowchart of maintenance hemodialysis patients evaluated for arteriovenous access flow and left ventricular mass index (LVMI).

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  Figure 2.. Relationship between arteriovenous access flow volume (FV) and left ventricular mass index (LVMI) demonstrating a flow-dependent remodeling pattern in hemodialysis patients (Model 1).

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  Figure 3.. Higher arteriovenous (AV) access flow increases venous return and left ventricular (LV) preload, leading to increased LV wall stress and subsequent LV hypertrophy/remodeling. This situation may ultimately contribute to adverse cardiovascular outcomes.

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  Figure 4.. Flow–cardiac load phenotype map integrating arteriovenous access flow volume, the LVMI, and echocardiographic features. The framework primarily distinguishes between ‘eccentric volume-dominant’ and ‘concentric load-dominant’ remodeling patterns and provides a practical taxonomy for flow-driven left ventricular remodeling. LVMI, left ventricular mass index; LVEDD, left ventricular end-diastolic diameter; IVST, interventricular septal thickness; PWT, posterior wall thickness; LVEF, left ventricular ejection fraction; LVH, left ventricular hypertrophy.

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  Figure 5.. Hypothesis-based, flow-guided surveillance algorithm for arteriovenous access-related cardiac load. Routine access flow surveillance prompts routine echocardiographic evaluation in moderate-to-high flow, focusing on LVH and/or LVMI progression, followed by flow–cardiac load phenotype assessment and proposed actions (volume optimization, evaluation of anemia/hyperglycaemia and preexisting cardiac disease [2], multidisciplinary review, and consideration of flow-modulating strategies). LVH, left ventricular hypertrophy; LVMI, left ventricular mass index.