#2506 Impact of atrial fibrillation on cardiac remodeling in patients on dialysis: insights from a longitudinal study
Notice bibliographique
Résumé
Abstract Background and Aims Atrial Fibrillation (AF) is the most common arrhythmia among patients on hemodialysis (HD), with a prevalence ranging between 15 and 40%. In the general population, AF is associated with cardiac remodeling and structural changes. In patients on HD, AF episodes mostly occur on dialysis days and may specifically be triggered by the HD procedure, when fluid and electrolytes shifts are taking place. Thus, whether AF in patients receiving HD is related to the development of structural changes in the heart remains unclear. Our aim was to study the association between AF and cardiac remodeling in incident HD patients, using echocardiographic parameters. Method A retrospective, longitudinal, cohort study was conducted. Patients started on maintenance HD at McGill University Health Center in Montreal, Canada between 1/1/2017 and 31/12/2022 were included. They were divided into AF and non-AF groups according to the presence or not of at least one AF episode on file. In the AF group, patients were considered as prevalent if the first AF episode was documented before dialysis initiation, otherwise AF was considered incident. The cohort was limited to patients who had ≥2 transthoracic echocardiograms (TTE), of which at least one before and one after dialysis initiation. For incident AF patients, at least one TTE after the first AF documentation was required. Patients were followed until the date of death, date of kidney transplantation, or September 1, 2024. Two continuous variables were created, AF burden and dialysis vintage. AF burden represents time (in years) since AF onset. For patients with prevalent AF, the date of dialysis initiation was considered as the date of onset. Dialysis vintage was defined as the time between dialysis initiation and AF onset (0 for prevalent AF patients). A complete case analysis was conducted. Linear mixed effects models were used to explore the association of AF burden and dialysis vintage with echocardiographic outcomes of interest, adjusting for use of renin angiotensin inhibitors. Inverse probability treatment weights (derived from propensity scores based on baseline covariates) were applied to reduce confounding. Results A total of 110 patients (49 with AF) were included in the analysis. Baseline characteristics of the patients with and without AF before and after inverse probability weighting are shown in Table 1. The weighted cohort was well balanced for all baseline characteristics. We found a significant association between AF burden and left ventricular end-diastolic volume index (LVEDVI), with a one-year increase in AF burden being associated with a reduction of 2.70 mL/m2 in LVEDVI (β = −2.70, 95% CI: −4.51 to −0.89, P < 0.01). In addition, dialysis vintage was significantly associated with a drop in LVEDVI (β = −2.08, 95% CI: −3.97 to −0.18, P = 0.03). In contrast, no significant association was found between AF burden or dialysis vintage and left atrial volume index (LAVI; β = 0.79, 95% CI: −1.36 to 2.95, P = 0.47). Furthermore, AF burden was not associated with changes in left ventricular ejection fraction (LVEF; β = −0.04 95% CI: −1.43 to 1.35, P = 0.96), left ventricular mass index (LVMI; β = −0.12, 95% CI: −4.64 to 4.40, P = 0.96), or pulmonary artery systolic pressure (PASP; β = 0.36, 95% CI: −1.57 to 2.28, P = 0.72). A trend towards lower LAVI and PASP was seen with longer dialysis vintage but this trend was not observed with increasing AF burden (Table 2). Conclusion In this study, both AF burden and dialysis vintage were significantly associated with a reduction in LVEDVI, suggesting potential ventricular remodeling or impaired filling which was more pronounced in patients on HD with AF. A trend towards lower LAVI and PASP was seen with longer dialysis vintage, possibly due to more effective decongestion, but this trend was no longer observed with increased AF burden, suggesting impaired left ventricular filling in patients with AF. No significant associations were observed between AF burden or dialysis vintage and LVMI or LVEF. These findings highlight the impact of AF on left ventricular remodeling in patients on maintenance HD and raise the question of a rhythm control strategy to prevent those changes.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».