{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T05:20:44Z","timestamp":1767676844830},"reference-count":11,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2021,9,12]],"date-time":"2021-09-12T00:00:00Z","timestamp":1631404800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Echocardiography"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>A hemodynamically significant arteriovenous fistula (AVF) in end\u2010stage kidney disease (ESKD) causes a high flow state, resulting in pathologic cardiovascular remodeling, and deserves timely clinical recognition.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case<\/jats:title><jats:p>A 55\u2010year\u2010old woman with history of ESKD with deceased donor kidney transplant with failing graft function and baseline creatinine of 2.8\u00a0mg\/dl presented to the clinic with nocturnal cough, orthopnea, dyspnea on exertion and pedal edema. Physical exam was notable for large, aneurysmal right brachial AVF. Transthoracic echocardiography (TTE) revealed left ventricular (LV) enlargement and hypertrophy and elevated cardiac output (CO) of 10\u00a0L\/min, raising a clinical concern for high\u2010output heart failure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Decision making<\/jats:title><jats:p>A non\u2010invasive assessment of the hemodynamic significance of the AVF was performed using a TTE. During temporary occlusion of the AVF, it was determined that about 27% of the resting CO was attributed to the AVF, suggesting hemodynamic significance. Nicoladoni\u2010Israel\u2010Branham sign was negative as there was no change in patient's heart rate, but this was potentially attributed to beta\u2010blockade and chronic loading conditions. She underwent AVF banding and 2\u2010month later her presenting symptoms resolved, and a TTE showed a decrease in resting CO of 7.6\u00a0L\/min with normalization of LV size.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This case highlights several teaching points. Firstly, in patients with ESKD, a large AVF can contribute to a high CO state resulting in maladaptive cardiovascular remodeling. Secondly, TTE evaluation of the hemodynamic contribution of an AVF can be performed with the application of the Nicoladoni\u2010Israel\u2010Branham sign. Finally, some experts recommend pre\u2010emptive banding or ligation of AVF after successful kidney transplantation as this has been shown to have symptomatic and cardiovascular benefits.<\/jats:p><\/jats:sec>","DOI":"10.1111\/echo.15195","type":"journal-article","created":{"date-parts":[[2021,9,12]],"date-time":"2021-09-12T17:13:00Z","timestamp":1631466780000},"page":"1817-1820","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["An indolent cause of high\u2010output heart failure in end\u2010stage kidney disease\u2014Application of the Nicoladoni\u2010Israel\u2010Branham test: A case report"],"prefix":"10.1111","volume":"38","author":[{"given":"Fredrick","family":"Ogugua","sequence":"first","affiliation":[{"name":"Department of Medicine Hennepin Healthcare  Minneapolis Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles 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