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Vascular access flow (Qa) can affect cardiac function in maintenance hemodialysis (HD) patients with heart failure and reduced ejection fraction of <40% (HFrEF). However, there has been little to no literature concerning the influence of cardiac function on Qa in this specific study population.
We retrospectively screened HD patients who have received echocardiogram and Qa measurements in two hospitals. Patients with HFrEF who have received twice of both the echocardiogram and Qa measurements 1 year apart were enrolled and divided into two groups – those with and without the treatment of sacubitril/valsartan. The differences in Qa (△Qa) and echocardiographic parameters after a 1-year treatment were compared between the two groups. The association between the △Qa and the differences in echocardiographic parameters was examined. Multiple linear regression was conducted to analyze whether or not the use of sacubitril/valsartan is a factor that may influence the △Qa and differences in echocardiographic parameters.
A total of 33 HD patients with HFrEF were analyzed and they presented a mean HD vintage of 4.7 years. Sixteen patients received sacubitril/valsartan and the other 17 patients received conventional treatment. The △Qa and differences in left ventricular ejection fraction (△LVEF), left ventricular internal diameter at end-systole, tissue Doppler-derived E/A ratio across the mitral valve, Doppler-derived medial E/e’ ratio showed statistical significance between the two groups. The △Qa was positively associated with △LVEF and was negatively associated with the differences in left ventricular end-systolic volume, interventricular septum thickness in diastole (△IVSd), left ventricular posterior wall thickness in diastole, and left ventricular mass index. The △Qa can be predicted as -44.034 + 15.868 x △LVEF - 25.072 x △IVSd + 145.964 x (in case of sacubitril/valsartan use), with R2 = 0.909 and adjusted R2 = 0.899.
The △Qa after 1-year treatment was significantly associated with △LVE, △IVSd, and sacubitril/valsartan use in HD patients with HFrEF.