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首页> 外文期刊>Circulation: An Official Journal of the American Heart Association >Effects of Arteriovenous Fistula Ligation on Cardiac Structure and Function in Kidney Transplant Recipients
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Effects of Arteriovenous Fistula Ligation on Cardiac Structure and Function in Kidney Transplant Recipients

机译：动静脉瘘结扎对肾移植受者心脏结构和功能的影响

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Background: Cardiovascular morbidity and mortality remain high in recipients of a kidney transplant. The persistence of a patent arteriovenous fistula (AVF) after transplantation may contribute to ongoing maladaptive cardiovascular remodeling. The ability to reverse this maladaptive remodeling by ligation of this AVF is unknown. We conducted the first randomized controlled trial to evaluate the effect of AVF ligation on cardiac structure and function in stable kidney transplant recipients. Methods: In this randomized controlled trial, kidney transplant recipients (>12 months after transplantation with stable graft function) were randomized to AVF ligation or no intervention. All participants underwent cardiac magnetic resonance imaging at baseline and at 6 months. The primary outcome was the change in left ventricular (LV) mass. Secondary outcomes included changes in LV volumes, left and right atrial areas, LV ejection fraction, NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels, cardiac output/index, brachial flows (ipsilateral to AVF), and pulmonary artery velocity. Results: A total of 93 patients were screened, of whom 64 met the inclusion criteria and were randomized to the AVF ligation (n=33) or control (n=31) group. Fifty-four participants completed the study: 27 in the AVF ligation group and 27 in the control group. On the second cardiac magnetic resonance scan, a mean decrease of 22.1 g (95% CI, 15.0-29.1) was observed in LV mass in the AVF ligation group compared with a small increase of 1.2 g (95% CI, -4.8 to 7.2) in the control group (P<0.001). Significant decreases in LV end-diastolic volumes, LV end-systolic volumes, cardiac output, cardiac index, atrial volumes, and NT-proBNP were also seen in the AVF closure group (P<0.01). No significant changes were observed in LV ejection fraction (P=0.93) and pulmonary artery velocity (P=0.07). No significant complications were noted after AVF ligation. No changes in estimated glomerular filtration rate or systolic and diastolic blood pressures were observed between cardiac magnetic resonance scans. Conclusions: Elective ligation of patent AVF in adults with stable kidney transplant function resulted in clinically significant reduction of LV myocardial mass.
机译：背景：肾移植受者的心血管发病率和死亡率仍然高。移植后专利动静脉瘘（AVF）的持续存在可能有助于持续的不良心血管重塑。通过连接这种AVF的逆转这种不良改造的能力是未知的。我们进行了第一次随机对照试验，以评估AVF结扎对稳定肾移植受体的心脏结构和功能的影响。方法：在该随机对照试验中，肾移植受者（用稳定接枝函数移植后12个月）随机连接到AVF结扎或无干预。所有参与者在基线和6个月内接受心脏磁共振成像。主要结果是左心室（LV）质量的变化。二次结果包括LV体积，左侧和右心房区域，LV喷射分数，NT-proPNP（N-末端Pro-B型利钠肽）水平，心脏输出/指数，肱臂流量（Ipsiloralal至Avf）和肺部动脉速度。结果：筛查共有93名患者，其中64均符合纳入标准，并随机分配到AVF连接（n = 33）或对照（n = 31）组。五十四名参与者完成了研究：27中的AVF结扎组和27中的对照组。在第二心脏磁共振扫描中，在AVF结扎组中，在AVF结扎组中观察到22.1g（95％CI，15.0-29.1）的平均降低，而是增加1.2g（95％CI，-4.8至7.2 ）在对照组中（p <0.001）。在AVF闭合组中还可以看到LV端舒张型体积，LV末端 - 收缩量，心输出，心脏指数，心房容量，心输出，心脏指数，心房容量和NT-PROPNP的显着降低（P <0.01）。在LV喷射级分（P = 0.93）和肺动脉速度下没有观察到显着变化（P = 0.07）。 AVF结扎后没有注意到明显的并发症。在心脏磁共振扫描之间观察到估计肾小球过滤速率或收缩性和舒张血压的变化。结论：具有稳定的肾移植函数的成人中专利AVF的选择性连接，导致LV心肌质量的临床显着降低。

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