Abstract Background Hemodialysis is one of the methods used to reduce the volume load and toxic substance level in end-stage renal disease.Arteriovenous fistulas provide the necessary vascular access for hemodialysis.In our study,we aimed to investigate possible changes in cardiac physiology by examining the effects of arteriovenous fistula on preoperative and postoperative right heart functions, myocardial work index and strain echocardiographic findings. Methods This study was designed as a single-center, prospective cross-sectional study to examine the early effects of arteriovenous fistula formation on cardiac functions.Advanced stage chronic renal failure who applied for arteriovenous fistula opening constituted the main group of our study. Conventional transthoracic echocardiography was performed on the patients before the operation, in the first 24 hours after the operation, and between 4-6 weeks after discharge.Blood samples were taken in the preoperative period and at the 1st month controls to study NT-pro BNP.In addition, fistula flow rates were calculated by color Doppler ultrasonography after fistula maturation was completed. The patients were divided into two groups as high and low flow rates according to control Doppler measurements. Results The study included 47 patients who applied to the cardiovascular surgery outpatient clinic for AVF surgery.An increase in left ventricular GLS was observed shortly after the AVF was created (p0.001). When myocardial Work parameters were examined, a significant increase was observed in GWI (p=0.001), GCW (p0.001) and GWE (p=0.029) in the early period, while no significant change was observed in GWW (p=0.515).A statistically significant decrease was observed in the right ventricular free wall longitudinal deformation values after the operation (p0.001).Echocardiographic examinations performed in the first 24 hours after the creation of the AVF revealed an increase in LV mass (p0.001) and LV mass index (p0.001).Significant changes in GLS(p0.001),GWI(p=0.014),GCW (p=0.011) and GWE (p=0.001) values continued in the first month controls.A statistically significant decrease was observed in GWW (p=0.013) at the end of the first month.NT-pro BNP significantly increased in the first month control compared to the preoperative values(p0.001).Patients were divided into two groups as high and low flow rates according to control Doppler measurements.LV mass was found to be increased in both groups, being more in the high-flow group.However, changes in GLS and myocardial work parameters were not correlated with increased output. Conclusion The data of this study suggest that cardiac changes may begin shortly after fistula formation, contrary to the general belief that cardiac remodeling develops in the long term in cases with AVF.Although the changes in strain and myocardial work parameters were significant,the parameters that showed the best correlation with fistula output were LV mass and LV mass index.
Arslanhan et al. (Sat,) studied this question.
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