High-Output Heart Failure Associated With Arteriovenous Fistula

초록

Background: Arteriovenous fistulas (AVFs) are the preferred vascular access for hemodialysis, but they can cause high-output heart failure (HOHF) by imposing significant hemodynamic stress. Despite its clinical significance, AVF-related HOHF remains under-recognized in hemodialysis patients. Case Summary: A 73-year-old woman on hemodialysis presented with progressive dyspnea. She had undergone upper-arm AVF surgery 1 year earlier. Transthoracic echocardiography revealed pericardial effusion and left ventricular enlargement. Right heart catheterization with simultaneous echocardiography showed a high cardiac index (5.5 L/min/m2) that promptly decreased to 3.3 L/min/m2 during manual AVF compression. Two AVF flow-reduction procedures resulted in a reduction in left ventricular size and symptomatic improvement. Discussion: This case highlights the need to consider HOHF in hemodialysis patients presenting with unexplained heart failure. Hemodynamic assessment—echocardiography or cardiac catheterization with AVF compression—can confirm the diagnosis and guide management. Take-Home Message: In suspected AVF-related HOHF, echocardiography with transient AVF flow reduction during hemodynamic testing can reverse the high-output state and support the diagnosis.

키워드