The effects of arteriovenous shunts on cardiac function in renal dialysis patients--an echocardiographic evaluation

Abstract

To estimate the flow rate in arteriovenous dialysis fistulae and its effect on cardiac function we investigated 7 dialysis patients (1 woman, 6 men, mean age 33 +/- 3 years) echocardiographically before and after 10 minutes occlusion of the arteriovenous shunt. Cardiac index was signigicantly raised (4.31 +/- 0.23 l/min/m2) and fell significantly into the normal range to 3.89 +/- 0.11 l/min/m2 after occlusion of the AV fistula. This reduction was mainly due to a fall in heart rate from 82 +/- 4 beats/min to 76 +/- 5 beats/min. The estimated AV fistula flow rate (0.71 +/- 0.17 l/m) has been similarly reported in invasive hemodynamic studies. Parameters of cardiac contractility were in the lower range of normal with an average of 1.16 +/- 0.10 circ/sec for the mean velocity of fiber shortening (Vcf) and 65 +/- 4% for the ejection fraction. These decreased minimally after fistula occlusion. The single echocardiographic measurements of Vcf and ejection fraction showed good correlation (r=0.97) and revealed evidence that only these patients with poor left ventricular function and septal hypertrophy showed improved cardiac performance after occlusion of the arteriovenous fistula. Thus echocardiography may offer the opportunity to select those patients who need small AV-fistulae for optimal renal and cardiac treatment.