Abstract: TH-PO280
Arteriovenous Shunts and Right Heart Function
Session Information
- Vascular Access: From Biology to Managing Complications
November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 703 Dialysis: Vascular Access
Authors
- Wing, Richard E., University of Rochester Medical Center, Rochester, New York, United States
- Rao, Nikhila Sri, University of Rochester Medical Center, Rochester, New York, United States
- Rao, Nilesh Sai, University of Rochester Medical Center, Rochester, New York, United States
- Tsai, Peihsuan R., University of Rochester Medical Center, Rochester, New York, United States
- Le, Thu H., University of Rochester Medical Center, Rochester, New York, United States
Background
Emerging evidence suggests that right ventricular dysfunction (RVD) is a major determinant of adverse health outcomes. Data regarding the effect of AV shunt placement on right heart function (RHF) is sparse.
Methods
We conducted a cross-sectional study on patients who received maintenance hemodialysis (HD) who were followed by URMC nephrology faculty. We identified subjects who underwent ambulatory echocardiograms (echos) within two years of each other. Original echocardiographic images were re-analyzed to assess RHF. Subjects who underwent construction of an AV shunt between echocardiograms (Group 1) were compared to subjects who did not undergo AV shunt construction between echos (Group 2).
Results
We identified 558 subjects with echos completed within two years of each other. Screening 300 of these subjects identified 54 who had two ambulatory echos within 2 years. Thus far, pairs of ambulatory echos have been analyzed for 10 subjects. RVD is defined as abnormality in any of the following: Myocardial Systolic Excursion Velocity (S') < 9.5 cm/sec, Tricuspid Annular Plane Systolic Excursion (TAPSE) < 17 mm, Right Ventricular Free Wall Strain (RVFWS) > -20%, or Right Ventricular Fractional Area Change (RVFAC) < 35%. Details are summarized in Table 1. Findings are reported as counts for discrete parameters or means for continuous parameters (standard deviation). All 20 echos had measurable TAPSE and RVFAC. In Group 1, S' could not be determined in the 1st echo for one subject and the 2nd echo in another subject. In Group 2, RVFWS could not be determined in the 2nd echo in one subject. All unmeassurable parameters were assumed to be normal.
Conclusion
RVD is remarkably common in patients with ESRD receiving hemodialysis. Larger studies with longitudinal data are needed to assess the impact of AVF on RVD in patients receiving maintenance hemodialysis.
Table 1. Select demographic, physical, and echocardiogenic parameters.