The impact of peripheral artery disease on left ventricular diastolic function

Peripheral artery disease (PAD) is often accompanied by heart failure with preserved ejection fraction (HFpEF). Left ventricular (LV) diastolic dysfunction is related to HFpEF. The aim of this study was to compare LV diastolic function between patients with or without PAD.

One thousand one hundred twenty-one patients (male 56%, mean age 68±13 years) with available preserved LV systolic function assessed by echocardiography (ejection fraction ≥50%) were enrolled from a single-center database between January 2013 and May 2015. PAD was defined as ankle brachial index <0.9 or previous history of lower extremity bypass and/or endovascular therapy. Diagnosis of LV diastolic dysfunction was based on the American Society of Echocardiography and European Association of Cardiovascular Imaging guidelines. The prevalence of LV diastolic dysfunction was compared between patients with PAD and those without PAD. Multivariate analysis was performed by logistic regression analyses to assess predictors of LV diastolic dysfunction.

Two hundred patients (18%) had PAD. Patients with PAD had higher E/e' (15.3±7.4 vs 11.8±5.5, p<0.01), tricuspid regurgitation velocity (2.37±0.33 vs 2.19±0.28m/s, p<0.01), left atrial volume index (40.6±20.2 vs 32.1±13.6mL/m², p<0.01), and lower e' (5.68±1.70 vs 6.38±2.07cm/s, p<0.01) than patients without PAD. The prevalence of LV diastolic dysfunction was higher (31% vs 12%, p<0.01) in patients with PAD compared to patients without PAD. Multivariate analysis showed that PAD was an independent predictor of LV diastolic dysfunction (adjusted odds ratio: 1.77, 95% confidence interval: 1.13-2.65, p=0.01).

The prevalence of LV diastolic dysfunction was higher in patients with PAD than patients without PAD.