[Heart failure and stasis ulcer: A significant association (prospective study of 100 cases)]

Risk factors for stasis ulcers have been poorly studied. We conducted a three-year controlled prospective study of the usual risk factors [venous insufficiency (VI), obesity, phlebitis] and of other factors suggested by our experience, such as heart failure (HF).

Both in-patients and out-patients referred for stasis ulcers were included. The diagnosis of stasis ulcer was based on clinical criteria: venous insufficiency, cutaneous signs and/or severe leg oedema. Doppler ultrasound was performed systematically if the lesions showed no dramatic improvement within two months of treatment to eliminate arterial ulcers. VI, liver cirrhosis, heart failure, deep venous thrombosis, obesity, after-effects of leg injury, homolateral artificial hip and knee joints, and consumption of anti-leukaemia or leg-oedema-eliciting drugs were the criteria analysed by clinical examination or by consulting the information in the hospital records. Data were analyzed using SPSS/PCv12 software. Chi(2) and Fischer's exact tests were to compare cases and controls, who were identical in age, gender, and department of initial contact for reasons other than leg ulcers, stasis eczema or lipodermatosclerosis.

We included 100 cases and 200 control subjects. Most were out-patients and only 4% were hospitalized in cardiology. Univariate analysis showed that stasis ulcer was significantly associated (p < 10(-4)) with VI (71% of cases versus 32.5% of control subjects), HF (44% versus 11%), obesity (44% versus 21.5%), after-effects of injury (17% versus 0%), and to a lesser extent, with artificial knee joints (7% versus 2.5%; p = 0.04). Multivariate analysis showed that stasis ulcer was strongly associated with VI (OR=5.5; 3-9.9) and HF (OR=4.7; 2.1-10.4). HF (right 16%, left 11%, global 57%, unspecified 16%) was also significantly associated with bilateral localization of leg ulcers (p = 10(-4)) but not with delayed healing (> 6 months).

This study highlights two risk factors for stasis ulcer: artificial knee joints (in the univariate analysis only) and HF. An increase in leg oedemas is probably an important mechanism but we suggest the role of hypoxaemia in patients with isolated left HF. We advise an internist approach in the management of venous leg ulcers, which we prefer to name stasis ulcers, before having ruled out a general disease. In particular, we recommend a consultation with a cardiologist in the event of doubt.