Effects of arteriovenous fistulas on cardiac oxygen supply and demand

被引:51
作者
Bos, WJW
Zietse, R
Wesseling, KH
Westerhof, N
机构
[1] Acad Med Ctr, Dept Nephrol, NL-1100 DD Amsterdam, Netherlands
[2] Acad Med Ctr, TNO, BMI, NL-1100 DD Amsterdam, Netherlands
[3] Free Univ Amsterdam, Physiol Lab, VU, ICAR, Amsterdam, Netherlands
[4] Univ Rotterdam Hosp, Dept Nephrol, Rotterdam, Netherlands
关键词
hemodialysis access; coronary perfusion; aortic pressure; systemic vascular resistance; cardiac output; brood pressure;
D O I
10.1046/j.1523-1755.1999.00433.x
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Background Arteriovenous (AV) fistulas used for hemodialysis access may affect cardiac load by increasing the preload while decreasing the afterload. In dogs, AV fistulas have also been shown to affect coronary perfusion negatively. We investigated the net effect of AV fistulas on cardiac oxygen supply and demand. Methods. Aortic pressure waves were reconstructed from finger pressure recordings obtained on the nonfistula arm using a wave-form filter. Changes in systolic, mean, and diastolic aortic pressure were calculated, together with changes in heart rate (HR), stroke volume (SV), cardiac output (CO), and systemic vascular resistance (SVR) during a 60-second compression of AV fistulas in 10 patients. Changes in cardiac supply and demand were estimated by calculating the area under the aortic pressure curve during diastole [diastolic pressure time index (DPTI)] and systole [systolic pressure time index (SPTI)], respectively. Results. During fistula compression, systolic, mean and diastolic pressure increased by 4.2 +/- 4.3, 2.6 +/- 3.0, and 2.8 +/- 2.9 mm Hg (mean +/- SD, all P < 0.05). The HR decreased by 3.8 +/- 2.5 beats per minute (P < 0.01), and SV decreased 3.7 +/- 6.1% (NS). CO decreased 9.4 +/- 8.6%, and SVR increased 14.3 +/- 11.7% (both P < 0.05). The SPTI increased by 1.5 +/- 1.5 mm Hg.sec (P < 0.01), and the DPTI increased by 7.6 +/- 8.1 mm Hg.sec (14.8% increase, P < 0.05) during compression. The ratio of supply and demand (DPTI/SPTI) improved by 13.5 +/- 13.0% (P < 0.01) when the fistula was compressed. Conclusion. AV fistulas have a small effect on left ventricular oxygen demand, but decrease cardiac oxygen supply considerably.
引用
收藏
页码:2049 / 2053
页数:5
相关论文
共 26 条
[1]   EFFECT OF DIALYSIS AND RENAL-TRANSPLANTATION ON AUTONOMIC DYSFUNCTION IN CHRONIC-RENAL-FAILURE [J].
AGARWAL, A ;
ANAND, IS ;
SAKHUJA, V ;
CHUGH, KS .
KIDNEY INTERNATIONAL, 1991, 40 (03) :489-495
[2]   HEART-FAILURE AS A COMPLICATION OF HEMODIALYSIS ARTERIOVENOUS FISTULA [J].
AHEARN, DJ ;
MAHER, JF .
ANNALS OF INTERNAL MEDICINE, 1972, 77 (02) :201-+
[3]   CARDIAC-FAILURE AND UPPER EXTREMITY ARTERIOVENOUS DIALYSIS FISTULAS - CASE-REPORTS AND A REVIEW OF LITERATURE [J].
ANDERSON, CB ;
CODD, JR ;
GRAFF, RA ;
GROCE, MA ;
HARTER, HR ;
NEWTON, WT .
ARCHIVES OF INTERNAL MEDICINE, 1976, 136 (03) :292-297
[4]   THE RELIABILITY OF NONINVASIVE CONTINUOUS FINGER BLOOD-PRESSURE MEASUREMENT IN PATIENTS WITH BOTH HYPERTENSION AND VASCULAR-DISEASE [J].
BOS, WJW ;
IMHOLZ, BPM ;
VANGOUDOEVER, J ;
WESSELING, KH ;
VANMONTFRANS, GA .
AMERICAN JOURNAL OF HYPERTENSION, 1992, 5 (08) :529-535
[5]   EFFECT OF REGIONAL AND SYSTEMIC CHANGES IN VASOMOTOR TONE ON FINGER PRESSURE AMPLIFICATION [J].
BOS, WJW ;
VANDENMEIRACKER, AH ;
WESSELING, KH ;
SCHALEKAMP, MADH .
HYPERTENSION, 1995, 26 (02) :315-320
[6]  
BOS WJW, 1995, KIDNEY INT, V48, P1641
[7]   Reconstruction of brachial artery pressure from noninvasive finger pressure measurements [J].
Bos, WJW ;
vanGoudoever, J ;
vanMontfrans, GA ;
vandenMeiracker, AH ;
Wesseling, KH .
CIRCULATION, 1996, 94 (08) :1870-1875
[8]   VARIABLE EFFECTS OF HEART-RATE ON PHASIC AND REGIONAL LEFT-VENTRICULAR MUSCLE BLOOD-FLOW IN ANESTHETIZED DOGS [J].
BUCKBERG, GD ;
FIXLER, DE ;
ARCHIE, JP ;
HENNEY, RP ;
HOFFMAN, JIE .
CARDIOVASCULAR RESEARCH, 1975, 9 (01) :1-11
[9]   EXPERIMENTAL SUBENDOCARDIAL ISCHEMIA IN DOGS WITH NORMAL CORONARY-ARTERIES [J].
BUCKBERG, GD ;
ARCHIE, JP ;
FIXLER, DE ;
HOFFMAN, JIE .
CIRCULATION RESEARCH, 1972, 30 (01) :67-+
[10]   CARDIAC WORK DEMANDS AND LEFT-VENTRICULAR FUNCTION IN END-STAGE RENAL-DISEASE [J].
CAPELLI, JP ;
KASPARIAN, H .
ANNALS OF INTERNAL MEDICINE, 1977, 86 (03) :261-267