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Initial diastolic dysfunction is a powerful predictor of 5-year mortality in peripheral arterial disease patients
Kyung-Hee Kim1, Saarwaani Vallabhajosyula2, Seung-Woon Rha3
1Cardiovascular Center, Sejong General Hospital, Incheon, South Korea.
Insights
Cardiac function, specifically elevated left atrial pressure (E/e' ≥ 15), independently predicts long-term mortality in peripheral arterial disease (PAD) patients. Reduced ejection fraction in PAD patients undergoing angioplasty indicates higher mortality risk.
Area of Science:
- Cardiology
- Vascular Medicine
- Echocardiography
Background:
- Peripheral arterial disease (PAD) and heart failure (HF) share risk factors and are linked to increased mortality.
- The predictive value of cardiac function for long-term mortality in PAD patients remains unclear.
Purpose of the Study:
- To investigate if cardiac function parameters, particularly left ventricular ejection fraction (LVEF), independently predict long-term mortality in patients with PAD.
- To identify specific echocardiographic markers associated with mortality in PAD patients.
Main Methods:
- A cohort of 902 patients undergoing percutaneous transluminal angioplasty (PTA) for PAD was analyzed.
- Patients were stratified into three groups based on LVEF: reduced (<40%), mid-range (40-49%), and preserved (≥50%).
- Echocardiographic parameters, including E/e' ratio, and clinical data were assessed using logistic regression to determine predictors of 5-year mortality.
Main Results:
- Patients with reduced and mid-range LVEF had a higher incidence of total death over 5 years compared to those with preserved LVEF.
- A higher proportion of patients with reduced LVEF had ischemic heart disease.
- The ratio of mitral inflow velocity to annular velocity (E/e') ≥ 15 was the sole independent predictor of total mortality (HR 6.14, p<0.01).
Conclusions:
- Reduced LVEF in PAD patients undergoing PTA is associated with increased 5-year mortality.
- Elevated left atrial filling pressure, estimated by E/e' ≥ 15, is a strong independent predictor of long-term mortality in PAD patients.
- This study highlights the significant relationship between cardiac dysfunction and outcomes in patients with peripheral arterial disease.
Abstract:
Peripheral arterial disease (PAD) and heart failure share common risks and are associated with increased morbidity and mortality. However, it is unknown whether cardiac function can be an independent predictor of long-term mortality in patients with PAD. In total, 902 patients who underwent percutaneous transluminal angioplasty for PAD were enrolled. The patients were categorized into three groups according to the left ventricular ejection fraction (LVEF): reduced EF (< 40%, n = 62); mid-range EF (40-49%, n = 76); and preserved EF (≥ 50%, n = 764). Echocardiographic (EF, ratio of mitral inflow velocity to annular velocity E/e' ≥ 15, and others) and clinical parameters were tested using stepwise logistic regression analysis to determine independent predictors of 5-year mortality. A higher proportion of patients with reduced EF had ischemic heart disease than those with preserved EF (77.4% vs. 56.8%, p < 0.001). Up to 5 years, patients with reduced EF and mid-range EF showed a higher incidence of total death than those with normal EF. However, there was no difference in the incidence of myocardial infarction, stroke, and revascularization among the three groups. After multivariable adjustment, the ratio of E/e' ≥ 15 was the only strong predictor of total mortality (hazard ratio 6.14; 95% confidence interval 3.7-10.1; p < 0.01). Patients with PAD and reduced EF undergoing PTA had a higher incidence of total death during the 5-year follow-up. Initial tissue Doppler E/e' ≥ 15, a non-invasive estimate of left atrial filling pressure, was the only independent predictor of long-term mortality. The relationship between PAD and HF.
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