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Prognostic Impact of Reduced Left Ventricular Ejection Fraction After Endovascular Therapy for Lower Extremities

Keiko Fukino1, Daisuke Ueshima2, Tetsuo Yamaguchi3

  • 1The Third Department of Internal Medicine, Teikyo University Chiba Medical Center.

Circulation Journal : Official Journal of the Japanese Circulation Society
|October 9, 2023
PubMed

Insights

Low left ventricular ejection fraction (LVEF) independently predicts adverse outcomes in lower-extremity artery disease (LEAD) patients undergoing endovascular therapy (EVT). Managing cardiac dysfunction is key to improving prognosis after EVT.

Area of Science:

  • Cardiovascular Medicine
  • Vascular Surgery
  • Interventional Cardiology

Background:

  • The prognostic implications of heart failure in patients with lower-extremity artery disease (LEAD) undergoing endovascular therapy (EVT) remain unclear.
  • Left ventricular ejection fraction (LVEF) is a critical indicator of cardiac function.
  • This study investigates the impact of LVEF on outcomes in LEAD patients treated with EVT.

Purpose of the Study:

  • To determine the prognostic significance of left ventricular ejection fraction (LVEF) in patients with lower-extremity artery disease (LEAD) undergoing endovascular therapy (EVT).
  • To assess whether low LVEF independently predicts major adverse cardiovascular and cerebrovascular events (MACCEs) and major adverse limb events (MALEs).

Main Methods:

  • A cohort of 2,180 patients with LEAD undergoing EVT between August 2014 and August 2016 was analyzed.
  • Patients were stratified into low-LVEF (LVEF <40%) and not-low LVEF groups.
  • Independent predictors of MACCEs and MALEs were identified using multivariable analysis.

Main Results:

  • The low-LVEF group had a higher prevalence of heart failure, diabetes, chronic kidney disease, and critical limb ischemia.
  • Low LVEF was independently associated with an increased incidence of MACCEs (HR: 2.23) and MALEs (HR: 1.85).
  • The association between low LVEF and adverse events was consistent, irrespective of symptomatic heart failure status.

Conclusions:

  • Low left ventricular ejection fraction (LVEF), rather than symptomatic heart failure alone, significantly increases the risk of MACCEs and MALEs in LEAD patients post-EVT.
  • Optimizing cardiac dysfunction management may be crucial for improving the prognosis of patients with LEAD undergoing EVT.
Abstract

Keywords:
Cardiac dysfunction managementEndovascular therapyHeart failureLeft ventricular ejection fractionLower-extremity artery disease

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