FC 100: Echocardiography: A Promising Screening and Monitoring Tool for Central Venous Stenosis in Hemodialysis Patients

Abstract

Abstract BACKGROUND AND AIMS Central venous stenosis (CVS) is a common but underestimated complication of vascular access in hemodialysis (HD) patients. The objective of this study was to compare the diagnostic efficacy of echocardiography and computed tomography angiography (CTA) for CVS in HD patients with access dysfunction. METHOD This was a retrospective study. HD patients with access dysfunction admitted to our institute between 1 April 2021 and 31 October 2021 were enrolled. Echocardiography, CTA and digital subtraction angiography (DSA) were performed to assess CVS. Receiver operator characteristic analysis was performed to compare the diagnostic efficacy of echocardiographic parameters and CTA for CVS, with DSA results as the reference standard. RESULTS A total of 167 HD patients (70 males, age 63 ± 13 years) were enrolled, among whom 99 (59%) were diagnosed with CVS based on DSA and only 9 presented with significant clinical symptoms of CVS. Among all of the echocardiographic parameters, superior vena cava (SVC) diameter showed the highest efficacy for CVS diagnosis (cut-off value ≤12 mm, specificity 70%, sensitivity 77%), which was equivalent to CTA (AUC 0.79 versus 0.81; P = 0.646) (Figure 1A). Some of the other echocardiographic parameters, including maximal and minimal right atrial volume (RAV), also showed moderated diagnostic efficacy for CVS. The specificity and sensitivity increased when echocardiography and CTA were used to diagnose brachiocephalic vein and SVC stenosis instead of total CVS (Figure 1B). Patients with CVS had a smaller SVC diameter (9.8 ± 3.5 mm versus 13.7 ± 3.3 mm; P < 0.001) and a reduced right RAV [RAV max median 20 (interquartile range 15–27) mL versus 31(24–39) mL; P < 0.001; RAV min 8 (5–10) mL versus 14 (10–17) mL; P < 0.001] compared with non-CVS patients. Spearman's rank correlation showed a significant negative correlation between RAV and hemodialysis vintage. CONCLUSION With equivalent diagnostic power for CVS to CTA, echocardiography has the potential to be used as a screening and monitoring tool for CVS in HD patients with access dysfunction.