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Published on: August 9, 2024
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
Summary
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.
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