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Long-term outcomes in patients with critical limb ischemia and heart failure with preserved or reduced ejection

Kavita B Khaira1, Ellen Brinza2, Gagan D Singh1

  • 11 Vascular Center and Division of Cardiovascular Medicine, Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA.

Vascular Medicine (London, England)
|July 12, 2017
PubMed

Insights

Patients with critical limb ischemia (CLI) and heart failure (HF) have significantly lower long-term survival. Survival rates were poor for both preserved and reduced ejection fraction heart failure, underscoring the severity of combined CLI and HF.

Area of Science:

  • Cardiology
  • Vascular Surgery
  • Internal Medicine

Background:

  • Heart failure (HF) significantly impacts patient outcomes, but its effect on long-term survival in critical limb ischemia (CLI) is not well-defined.
  • Outcomes in CLI patients with HF, stratified by left ventricular ejection fraction (EF), remain largely unknown.

Purpose of the Study:

  • To investigate the impact of heart failure (HF) on long-term survival in patients with critical limb ischemia (CLI).
  • To compare outcomes based on the presence and type of heart failure (HFpEF vs. HFrEF) in CLI patients.

Main Methods:

  • Retrospective chart review of 381 patients treated for CLI between 2006 and 2013.
  • Analysis of baseline demographics, procedural data, and outcomes, including HF diagnosis and left ventricular ejection fraction (EF).
  • Stratification of patients into no-HF, HF with preserved ejection fraction (HFpEF), and HF with reduced ejection fraction (HFrEF) groups.

Main Results:

  • 31% of CLI patients had a history of HF (120 patients), with 62% having HFpEF and 38% having HFrEF.
  • Five-year survival was twofold higher in the no-HF group (43%) compared to HFpEF (19%) and HFrEF (24%) groups (p=0.001).
  • No significant difference in 5-year survival between HFpEF and HFrEF groups (p=0.50); amputation-free survival did not differ across groups.

Conclusions:

  • The combination of CLI and HF is associated with poor 5-year survival, regardless of left ventricular systolic function.
  • Heart failure significantly worsens long-term survival in patients with critical limb ischemia.
  • Further research into managing combined CLI and HF is warranted to improve patient prognosis.

Keywords:
critical limb ischemia (CLI)heart failureleft ventricular ejection fractionperipheral artery disease (PAD)

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