Abstract: FR-PO526
Probability of Heart Failure with Preserved Ejection Fraction and Outcomes after Arteriovenous Fistula Creation
Session Information
- Dialysis Vascular Access
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 803 Dialysis: Vascular Access
Authors
- Kanamori, Karina S., Mayo Clinic, Department of Cardiovascular Medicine, Rochester, MN, Rochester, Minnesota, United States
- Dilmaghani, Darah, Mayo Clinic Department of Internal Medicine, Rochester, Minnesota, United States
- Borlaug, Barry A., Mayo Clinic, Department of Cardiovascular Medicine, Rochester, MN, Rochester, Minnesota, United States
- Garovic, Vesna D., Mayo Clinic Department of Internal Medicine, Rochester, Minnesota, United States
- Nath, Karl A., Mayo Clinic Department of Internal Medicine, Rochester, Minnesota, United States
- Reddy, Yogesh N.v., Mayo Clinic, Department of Cardiovascular Medicine, Rochester, MN, Rochester, Minnesota, United States
Background
End stage renal disease (ESRD) patients develop symptomatic fluid retention related to renal failure with difficulty to differentiate from heart failure (HF). Therefore, clinical implications of co-existing myocardial dysfunction related to HF with preserved ejection fraction (HFpEF) on outcomes in ESRD following arteriovenous fistula creation (AVF) remain unknown.
Methods
Patients undergoing AVF from 2000 to 2015 who had echocardiography (echo) before AVF were retrospectively reviewed. HF with reduced ejection fraction (HFrEF) was defined by baseline EF<50%. Among those with EF>50%, baseline probability of HFpEF was determined using a validated HFpEF score algorithm. Patients at risk for HFpEF were stratified as low(<25%), intermediate(25-75%) and high(>75%) probability. Baseline cardiac structure and function by echo and outcomes of mortality, HF hospitalization, and AVF maturation rate were compared across HFpEF probability groups.
Results
There were 366 patients(213 men) who underwent AVF and had echo before the procedure. Most patients(79%) had EF>50% at the time of AVF, while 21% had HFrEF. Of those with EF>50%, 131(45%) had high, 120(41%) had intermediate and 39(13%) had low probability for HFpEF. Higher HFpEF probability grouping was associated with higher echo estimated filling pressures as assessed by E/e’(13.4±5.1, 16.6±7.3, 19.0±8.7, p=0.0008), larger LA volume index(33.3±12.2. 37.3±11.7, 43.0±15.3, p=0.0006), higher right atrial pressure(5.9±2.3, 7.3±3.9, 8.8±4.2, p=0.0003), higher pulmonary artery systolic pressure(33.8±10.7, 40.1±13.7, 45.3±13.8, p=0.0003) and increased LV mass(200±79, 225±76, 246±86, p=0.01). AVF maturation rates were not different across HFpEF probability groups(31,33,35% p=0.56). Increasing HFpEF probability was associated with worse survival(HR per decile of HFpEF probability 1.11 [95%CI 1.06-1.17], p<0.0001) and increased risk of death or HF hospitalization(HR per decile of HFpEF probability 1.12 [95%CI 1.07-1.18], p<0.0001).
Conclusion
Increasing probability of HFpEF in patients with ESRD undergoing AVF is associated with worse cardiac remodeling and increased risk of death and HF hospitalization on maintenance hemodialysis. Whether treatment targeting the myocardial HFpEF component in patients with ESRD is beneficial requires further study.
Funding
- Other NIH Support