Systemic vascular resistance predicts high‐output cardiac failure in patients with high‐flow arteriovenous fistula
Abstract Aims Patients with high‐flow arteriovenous (AV) access are at risk of developing high‐output cardiac failure (HOCF) and subsequent hospitalization. However, diagnosing HOCF is challenging and often requires invasive procedures. The role of systemic vascular resistance (SVR) in diagnosing HO...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2024-02-01
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| Series: | ESC Heart Failure |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ehf2.14563 |
| _version_ | 1797348456297136128 |
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| author | Dan‐Ying Lee Ting Chen Wei‐Chieh Huang Ruey‐Hsing Chou Cheng‐Hsueh Wu Chih‐Yu Yang Chiu‐Yang Lee Chih‐Ching Lin Der‐Cherng Tarng |
| author_facet | Dan‐Ying Lee Ting Chen Wei‐Chieh Huang Ruey‐Hsing Chou Cheng‐Hsueh Wu Chih‐Yu Yang Chiu‐Yang Lee Chih‐Ching Lin Der‐Cherng Tarng |
| author_sort | Dan‐Ying Lee |
| collection | DOAJ |
| description | Abstract Aims Patients with high‐flow arteriovenous (AV) access are at risk of developing high‐output cardiac failure (HOCF) and subsequent hospitalization. However, diagnosing HOCF is challenging and often requires invasive procedures. The role of systemic vascular resistance (SVR) in diagnosing HOCF is underestimated, and its predictive value is limited. Our study aims to identify non‐invasive risk factors for HOCF to facilitate early diagnosis and timely surgical interventions. Methods and results We included 109 patients with high‐flow AV access who underwent serial echocardiography. The retrospective cohort was divided into two groups based on their hospitalization due to HOCF. The two groups were matched for age and gender. After a mean follow‐up of 25.1 months, 19 patients (17.4%) were hospitalized due to HOCF. The two groups had similar baseline characteristics. However, the HOCF group had a higher value of vascular access blood flow (Qa) (2168 ± 856 vs. 1828 ± 617 mL/min; P = 0.045). Echocardiographic analysis revealed that the HOCF group had more pronounced left ventricular diastolic dysfunction (E/e′: 21.1 ± 7.3 vs. 16.2 ± 5.9; P = 0.002), more severe pulmonary hypertension (right ventricular systolic pressure: 41.4 ± 16.7 vs. 32.2 ± 12.8; P = 0.009), a higher Doppler‐derived cardiac index (CI) (4.3 ± 0.8 vs. 3.7 ± 1.1; P = 0.031), and a lower Doppler‐derived estimated SVR (eSVR) value (5.5 ± 0.3 vs. 6.9 ± 0.2; P = 0.002) than the non‐HOCF group. Using multivariable Cox regression analysis, a low eSVR value (<6) emerged as an independent predictor of HOCF hospitalization with a hazard ratio of 9.084 (95% confidence interval, 2.33–35.39; P = 0.001). Receiver operating characteristic curve analysis indicated that CI/eSVR values more accurately predicted HOCF hospitalization [sensitivity: 94.7%, specificity: 51.0%, area under the curve (AUC): 0.75, P < 0.001] than the Qa/cardiac output ratio (AUC: 0.50, P = 0.955), Qa values ≥ 2000 mL/min (AUC: 0.60, P = 0.181), and Qa values indexed for height in metres (AUC: 0.65, P = 0.040). Conclusions In patients with high‐flow AV access, low eSVR values obtained through non‐invasive Doppler echocardiography were associated with a high rate of HOCF hospitalizations. Therefore, routine eSVR screening in these patients might expedite the diagnosis of HOCF. |
| first_indexed | 2024-03-08T12:06:09Z |
| format | Article |
| id | doaj.art-e19a4b9daa644945873664aa45451c8c |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-03-08T12:06:09Z |
| publishDate | 2024-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-e19a4b9daa644945873664aa45451c8c2024-01-23T08:40:25ZengWileyESC Heart Failure2055-58222024-02-0111118919710.1002/ehf2.14563Systemic vascular resistance predicts high‐output cardiac failure in patients with high‐flow arteriovenous fistulaDan‐Ying Lee0Ting Chen1Wei‐Chieh Huang2Ruey‐Hsing Chou3Cheng‐Hsueh Wu4Chih‐Yu Yang5Chiu‐Yang Lee6Chih‐Ching Lin7Der‐Cherng Tarng8Division of Cardiology, Department of Medicine Taipei Veterans General Hospital No. 201, Section 2, Shih‐Pai Road, Beitou District Taipei TaiwanDivision of Nephrology, Department of Medicine Taipei Veterans General Hospital No. 201, Section 2, Shih‐Pai Road, Beitou District Taipei TaiwanDivision of Cardiology, Department of Medicine Taipei Veterans General Hospital No. 201, Section 2, Shih‐Pai Road, Beitou District Taipei TaiwanDivision of Cardiology, Department of Medicine Taipei Veterans General Hospital No. 201, Section 2, Shih‐Pai Road, Beitou District Taipei TaiwanDivision of Cardiology, Department of Medicine Taipei Veterans General Hospital No. 201, Section 2, Shih‐Pai Road, Beitou District Taipei TaiwanFaculty of Medicine National Yang Ming Chiao Tung University School of Medicine Taipei TaiwanFaculty of Medicine National Yang Ming Chiao Tung University School of Medicine Taipei TaiwanFaculty of Medicine National Yang Ming Chiao Tung University School of Medicine Taipei TaiwanFaculty of Medicine National Yang Ming Chiao Tung University School of Medicine Taipei TaiwanAbstract Aims Patients with high‐flow arteriovenous (AV) access are at risk of developing high‐output cardiac failure (HOCF) and subsequent hospitalization. However, diagnosing HOCF is challenging and often requires invasive procedures. The role of systemic vascular resistance (SVR) in diagnosing HOCF is underestimated, and its predictive value is limited. Our study aims to identify non‐invasive risk factors for HOCF to facilitate early diagnosis and timely surgical interventions. Methods and results We included 109 patients with high‐flow AV access who underwent serial echocardiography. The retrospective cohort was divided into two groups based on their hospitalization due to HOCF. The two groups were matched for age and gender. After a mean follow‐up of 25.1 months, 19 patients (17.4%) were hospitalized due to HOCF. The two groups had similar baseline characteristics. However, the HOCF group had a higher value of vascular access blood flow (Qa) (2168 ± 856 vs. 1828 ± 617 mL/min; P = 0.045). Echocardiographic analysis revealed that the HOCF group had more pronounced left ventricular diastolic dysfunction (E/e′: 21.1 ± 7.3 vs. 16.2 ± 5.9; P = 0.002), more severe pulmonary hypertension (right ventricular systolic pressure: 41.4 ± 16.7 vs. 32.2 ± 12.8; P = 0.009), a higher Doppler‐derived cardiac index (CI) (4.3 ± 0.8 vs. 3.7 ± 1.1; P = 0.031), and a lower Doppler‐derived estimated SVR (eSVR) value (5.5 ± 0.3 vs. 6.9 ± 0.2; P = 0.002) than the non‐HOCF group. Using multivariable Cox regression analysis, a low eSVR value (<6) emerged as an independent predictor of HOCF hospitalization with a hazard ratio of 9.084 (95% confidence interval, 2.33–35.39; P = 0.001). Receiver operating characteristic curve analysis indicated that CI/eSVR values more accurately predicted HOCF hospitalization [sensitivity: 94.7%, specificity: 51.0%, area under the curve (AUC): 0.75, P < 0.001] than the Qa/cardiac output ratio (AUC: 0.50, P = 0.955), Qa values ≥ 2000 mL/min (AUC: 0.60, P = 0.181), and Qa values indexed for height in metres (AUC: 0.65, P = 0.040). Conclusions In patients with high‐flow AV access, low eSVR values obtained through non‐invasive Doppler echocardiography were associated with a high rate of HOCF hospitalizations. Therefore, routine eSVR screening in these patients might expedite the diagnosis of HOCF.https://doi.org/10.1002/ehf2.14563High‐output cardiac failureArteriovenous fistulaVascular accessHigh flowEstimated systemic vascular resistance |
| spellingShingle | Dan‐Ying Lee Ting Chen Wei‐Chieh Huang Ruey‐Hsing Chou Cheng‐Hsueh Wu Chih‐Yu Yang Chiu‐Yang Lee Chih‐Ching Lin Der‐Cherng Tarng Systemic vascular resistance predicts high‐output cardiac failure in patients with high‐flow arteriovenous fistula ESC Heart Failure High‐output cardiac failure Arteriovenous fistula Vascular access High flow Estimated systemic vascular resistance |
| title | Systemic vascular resistance predicts high‐output cardiac failure in patients with high‐flow arteriovenous fistula |
| title_full | Systemic vascular resistance predicts high‐output cardiac failure in patients with high‐flow arteriovenous fistula |
| title_fullStr | Systemic vascular resistance predicts high‐output cardiac failure in patients with high‐flow arteriovenous fistula |
| title_full_unstemmed | Systemic vascular resistance predicts high‐output cardiac failure in patients with high‐flow arteriovenous fistula |
| title_short | Systemic vascular resistance predicts high‐output cardiac failure in patients with high‐flow arteriovenous fistula |
| title_sort | systemic vascular resistance predicts high output cardiac failure in patients with high flow arteriovenous fistula |
| topic | High‐output cardiac failure Arteriovenous fistula Vascular access High flow Estimated systemic vascular resistance |
| url | https://doi.org/10.1002/ehf2.14563 |
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