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Improving risk assessment with cardiac testing in peripheral arterial disease

Harm H H Feringa1, Abdou Elhendy, Stefanos E Karagiannis

  • 1Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.

The American Journal of Medicine
|May 26, 2007
PubMed

Insights

Left ventricular ejection fraction and stress-induced ischemia are key predictors of mortality and cardiac events in peripheral arterial disease patients. These factors, along with ankle-brachial index, improve risk assessment for better patient outcomes.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Diagnostic Imaging

Background:

  • Peripheral arterial disease (PAD) is linked to increased cardiovascular risk.
  • Accurate prognostic assessment in PAD patients is crucial for guiding treatment strategies.
  • Traditional risk factors and ankle-brachial index (ABI) have limitations in predicting outcomes.

Purpose of the Study:

  • To evaluate the prognostic value of left ventricular ejection fraction (LVEF) and stress-induced ischemia.
  • To assess the combined predictive power of LVEF, ischemia, ABI, and clinical risk factors.
  • To determine if echocardiographic parameters improve risk stratification in suspected or known PAD.

Main Methods:

  • 852 patients with suspected or known PAD underwent ABI measurement and dobutamine stress echocardiography.
  • Left ventricular ejection fraction (LVEF) was assessed, and stress-induced ischemia was identified.
  • Endpoints included all-cause mortality and hard cardiac events over a mean follow-up of 7.6 years.

Main Results:

  • Lower LVEF and presence of stress-induced ischemia independently predicted higher all-cause mortality and hard cardiac events.
  • Each 5% decrease in LVEF was associated with increased mortality and cardiac events.
  • Stress-induced ischemia significantly increased the risk of both mortality and hard cardiac events.

Conclusions:

  • Left ventricular ejection fraction and stress-induced ischemia provide independent prognostic information in PAD patients.
  • These echocardiographic parameters significantly enhance risk assessment beyond ABI and clinical factors.
  • Integrating LVEF and ischemia assessment can optimize long-term outcome prediction in PAD.
Abstract

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