{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T15:25:47Z","timestamp":1770996347754,"version":"3.50.1"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T00:00:00Z","timestamp":1767916800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003243","name":"Ministerstvo Zdravotnictv\u00ed Cesk\u00e9 Republiky","doi-asserted-by":"publisher","award":["00064165"],"award-info":[{"award-number":["00064165"]}],"id":[{"id":"10.13039\/501100003243","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>High-output heart failure (HOHF) is a distinct cardiac complication in end-stage kidney disease (ESKD) patients with high-flow arteriovenous fistulae (AVFs). While AVF flow reduction improves hemodynamics and left atrial (LA) volume, its effect on LA systolic function remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate changes in left atrial systolic function and left ventricular (LV) filling pressures following surgical AVF flow reduction in haemodialysis patients with high-flow fistulae.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this prospective, single-centre interventional study, 28 ESKD patients (mean age 63 \u00b1 15 years) with high-flow AVFs (&amp;gt;1,500 mL\/min) and clinical heart failure (NYHA \u2265 II) underwent surgical AVF flow reduction. Echocardiographic assessments were performed before and 6 weeks after intervention. LA ejection fraction (LAEF) and LV filling pressures (E\/e\u2032 ratio) were determined from digitally stored imaging data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Surgical intervention reduced AVF flow by approximately 50% [2,525 [1,388] to 1,250 [700] mL\/min,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.00006]. LA volume index decreased significantly (44.7 \u00b1 17.3 to 38.5 \u00b1 15.4 mL\/m\n                      <jats:sup>2<\/jats:sup>\n                      ,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.01), accompanied by an improvement in LAEF (49.6 \u00b1 14.9% to 53.2 \u00b1 13.5%,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.046). Dyspnoea improved or resolved in all patients. Baseline LAEF correlated negatively with age, LA volume index, and NYHA class, but no independent predictors of post-operative LAEF improvement were identified.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In patients with high-flow AVF\u2013associated HOHF, surgical AVF flow reduction leads to a significant improvement in LA systolic function alongside decreased LA volume. These findings suggest partial reversibility of atrial remodeling induced by chronic hyperkinetic circulation and highlight the potential cardiovascular benefits of AVF flow optimization in selected dialysis patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2025.1732862","type":"journal-article","created":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T05:15:31Z","timestamp":1767935731000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Improvement of the left atrial systolic function after a surgical reduction of the high flow arteriovenous fistula"],"prefix":"10.3389","volume":"12","author":[{"given":"Vaclav","family":"Lejsek","sequence":"first","affiliation":[{"name":"Third Department of Internal Medicine, First Faculty of Medicine, General University Hospital in Prague, Charles University","place":["Prague, Czechia"]},{"name":"Cardiology Department, Institute for Clinical and Experimental Medicine","place":["Prague, Czechia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Valerianova","sequence":"additional","affiliation":[{"name":"Third Department of Internal Medicine, First Faculty of Medicine, General University Hospital in Prague, Charles University","place":["Prague, Czechia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristyna","family":"Michalickova","sequence":"additional","affiliation":[{"name":"Third Department of Internal Medicine, First Faculty of Medicine, General University Hospital in Prague, Charles University","place":["Prague, Czechia"]},{"name":"Department of Internal Medicine, First Medical Faculty, Charles University and Central Military Hospital Prague","place":["Prague, Czechia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristina","family":"Buryskova Salajova","sequence":"additional","affiliation":[{"name":"Third Department of Internal Medicine, First Faculty of Medicine, General University Hospital in Prague, Charles University","place":["Prague, Czechia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcela","family":"Slavikova","sequence":"additional","affiliation":[{"name":"Second Department of Surgery, First Faculty of Medicine, General University Hospital in Prague, Charles University","place":["Prague, Czechia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marian","family":"Rybar","sequence":"additional","affiliation":[{"name":"Faculty of Biomedical Engineering, Czech Technical University in Prague","place":["Kladno, Czechia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan","family":"Malik","sequence":"additional","affiliation":[{"name":"Third Department of Internal Medicine, First Faculty of Medicine, General University Hospital in Prague, Charles University","place":["Prague, Czechia"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1038\/s41581-024-00820-6","article-title":"Chronic kidney disease and the global public health agenda: an international consensus","volume":"20","author":"Francis","year":"2024","journal-title":"Nat Rev Nephrol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1238","DOI":"10.1016\/S0140-6736(16)32064-5","article-title":"Chronic kidney disease","volume":"389","author":"Webster","year":"2017","journal-title":"Lancet."},{"key":"B3","doi-asserted-by":"publisher","first-page":"e70174","DOI":"10.1002\/clc.70174","article-title":"Trends in cardiovascular mortality in patients with chronic kidney disease from 1999 to 2020: a retrospective study in the United States","volume":"48","author":"Ahmad","year":"2025","journal-title":"Clin Cardiol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1007\/s11883-024-01191-w","article-title":"Increased cardiovascular risk in young patients with CKD and the role of lipid-lowering therapy","volume":"26","author":"Kratky","year":"2024","journal-title":"Curr Atheroscler Rep."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1304","DOI":"10.1016\/j.kint.2019.02.022","article-title":"Heart failure in chronic kidney disease: conclusions from a kidney disease: improving global outcomes (KDIGO) controversies conference","volume":"95","author":"House","year":"2019","journal-title":"Kidney Int"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1130618","DOI":"10.3389\/fcvm.2023.1130618","article-title":"Heart failure with preserved ejection fraction is the most frequent but commonly overlooked phenotype in patients on chronic hemodialysis","volume":"10","author":"Malik","year":"2023","journal-title":"Front Cardiovasc Med."},{"key":"B7","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1159\/000473868","article-title":"Heart failure with preserved and reduced ejection fraction in hemodialysis patients: prevalence, disease prediction and prognosis","volume":"42","author":"Antlanger","year":"2017","journal-title":"Kidney Blood Press Res."},{"key":"B8","doi-asserted-by":"publisher","first-page":"362","DOI":"10.3949\/ccjm.92a.24114","article-title":"High-output heart failure from arteriovenous dialysis access: a structured approach to diagnosis and management","volume":"92","author":"Volk","year":"2025","journal-title":"Cleve Clin J Med"},{"key":"B9","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1016\/j.jacc.2016.05.043","article-title":"High-output heart failure: a 15-year experience","volume":"68","author":"Reddy","year":"2016","journal-title":"J Am Coll Cardiol."},{"key":"B10","doi-asserted-by":"publisher","first-page":"2165","DOI":"10.1002\/ehf2.13305","article-title":"The effect of high-flow arteriovenous fistulas on systemic haemodynamics and brain oxygenation","volume":"8","author":"Malik","year":"2021","journal-title":"ESC Heart Fail."},{"key":"B11","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1016\/j.ijcard.2021.04.027","article-title":"Reduction of arteriovenous access blood flow leads to biventricular unloading in haemodialysis patients","volume":"334","author":"Valerianova","year":"2021","journal-title":"Int J Cardiol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"e028496","DOI":"10.1161\/JAHA.122.028496","article-title":"Association of chronic kidney disease with atrial fibrillation in the general adult population: a nationwide population-based study","volume":"12","author":"Kim","year":"2023","journal-title":"J Am Heart Assoc"},{"key":"B13","doi-asserted-by":"publisher","first-page":"2485390","DOI":"10.1080\/0886022X.2025.2485390","article-title":"Comparative analysis of left atrial volume and strain parameters in hemodialysis vs. peritoneal dialysis patients using four-dimensional automatic quantification technology","volume":"47","author":"Jin","year":"2025","journal-title":"Ren Fail"},{"key":"B14","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1159\/000447500","article-title":"Left atrial dysfunction in end-stage renal disease patients treated by hemodialysis","volume":"133","author":"Malik","year":"2016","journal-title":"Nephron"},{"key":"B15","doi-asserted-by":"publisher","first-page":"e15784","DOI":"10.1111\/echo.15784","article-title":"Effect of hemodialysis on left atrial function in patients with end-stage renal failure evaluated by two-dimensional speckle tracking imaging","volume":"41","author":"Miao","year":"2024","journal-title":"Echocardiography."},{"key":"B16","doi-asserted-by":"publisher","first-page":"2179","DOI":"10.1007\/s00467-022-05812-x","article-title":"Plasma FGF23 is associated with left atrial remodeling in children on hemodialysis","volume":"38","author":"Sharma","year":"2023","journal-title":"Pediatr. Nephrol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"100730","DOI":"10.1016\/j.clinsp.2025.100730","article-title":"Left atrial reverse remodeling in patients with persistent atrial fibrillation and HFpEF following radiofrequency ablation: prospective evaluation with echocardiographic atrial analysis","volume":"80","author":"Chen","year":"2025","journal-title":"Clinics (Sao Paulo)."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1377958","DOI":"10.3389\/fcvm.2024.1377958","article-title":"Changes in left atrial function following two regimens of combined exercise training in patients with ischemic cardiomyopathy: a pilot study","volume":"11","author":"Caminiti","year":"2024","journal-title":"Front Cardiovasc Med."},{"key":"B19","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1007\/BF03091770","article-title":"Age is an independent risk factor for left atrial dysfunction: results from an observational study","volume":"18","author":"Ploumen","year":"2010","journal-title":"Neth Heart J."},{"key":"B20","doi-asserted-by":"publisher","first-page":"e008435","DOI":"10.1161\/JAHA.117.008435","article-title":"Association of left atrial function index with atrial fibrillation and cardiovascular disease: the Framingham offspring study","volume":"7","author":"Sardana","year":"2018","journal-title":"J Am Heart Assoc."},{"key":"B21","doi-asserted-by":"publisher","first-page":"341","DOI":"10.5603\/KP.2013.0061","article-title":"Evaluation of left atrial function using two-dimensional speckle tracking echocardiography in end-stage renal disease patients with preserved left ventricular ejection fraction","volume":"71","author":"Altekin","year":"2013","journal-title":"Kardiol Pol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"1093","DOI":"10.3390\/jpm14111093","article-title":"Left atrial strain: state of the art and clinical implications","volume":"14","author":"Javadi","year":"2024","journal-title":"J Pers Med."},{"key":"B23","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1111\/j.1525-139X.2007.00244.x","article-title":"Inflow reduction by distalization of anastomosis treats efficiently high-inflow high-cardiac output vascular access for hemodialysis","volume":"20","author":"Chemla","year":"2007","journal-title":"Semin Dial."},{"key":"B24","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1016\/j.avsg.2015.08.012","article-title":"Treatment of high flow arteriovenous fistulas after successful renal transplant using a simple precision banding technique","volume":"31","author":"Gkotsis","year":"2016","journal-title":"Ann Vasc Surg."}],"updated-by":[{"DOI":"10.3389\/fmed.2026.1784889","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T00:00:00Z","timestamp":1770940800000}}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1732862\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T14:46:57Z","timestamp":1770994017000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1732862\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,9]]},"references-count":24,"alternative-id":["10.3389\/fmed.2025.1732862"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1732862","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,9]]},"article-number":"1732862"}}