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Calf rEF: Impact of Calf Muscle Pump Dysfunction With Reduced Ejection Fraction on All-Cause Mortality
Robert D McBane1, David Liedl1, Waldemar Wysokinski1
1Gonda Vascular Center, Mayo Clinic, Rochester, MN; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
Insights
Reduced calf muscle pump ejection fraction (CMP EF) is linked to higher mortality. As CMP EF decreases, mortality risk significantly increases, independent of venous valvular issues.
Area of Science:
- Vascular Medicine
- Cardiovascular Physiology
- Clinical Outcomes Research
Background:
- Calf muscle pump (CMP) ejection fraction (EF) is a key measure of venous function.
- Reduced CMP EF may be associated with adverse health outcomes.
- Understanding the relationship between CMP EF and mortality is crucial for patient management.
Purpose of the Study:
- To investigate the association between varying degrees of reduced calf muscle pump ejection fraction (CMP EF) and all-cause mortality.
- To determine if venous valvular incompetence or clinical venous disease severity influences this relationship.
Main Methods:
- Retrospective analysis of 5913 adult patients undergoing venous air plethysmography.
- Patients categorized into groups based on CMP EF.
- Mortality assessed using Kaplan-Meier analysis and Cox proportional hazards models, adjusting for covariates.
Main Results:
- Mortality rates increased significantly with decreasing CMP EF (log-rank P≤.001).
- Hazard ratios for mortality increased from 1.4 (95% CI, 1.0 to 2.0) for EF 40-49% to 2.4 (95% CI, 1.7 to 3.3) for EF 10-19%, compared to EF ≥50%.
- Clinical Venous Disease (CEAP) score predicted mortality, but venous valvular incompetence did not independently predict outcomes. Both CMP EF and CEAP score remained independent predictors of mortality after adjustment.
Conclusions:
- Reduced calf muscle pump ejection fraction is an independent predictor of increased all-cause mortality.
- Mortality risk escalates with progressive declines in CMP EF.
- The mechanism of increased mortality appears related to muscular physiology rather than venous valvular incompetence.
Objective:
To evaluate mortality outcomes by varying degrees of reduced calf muscle pump (CMP) ejection fraction (EF).
Patients And Methods:
Consecutive adult patients who underwent venous air plethysmography testing at the Mayo Clinic Gonda Vascular Laboratory (January 1, 2012, through December 31, 2022) were divided into groups based on CMP EF for the assessment of all-cause mortality. Other venous physiology included measures of valvular incompetence and clinical venous disease (CEAP [clinical presentation, etiology, anatomy, and pathophysiology] score). Mortality rates were calculated using the Kaplan-Meier method.
Results:
During the study, 5913 patients met the inclusion criteria. During 2.84-year median follow-up, there were 431 deaths. Mortality rates increased with decreasing CMP EF. Compared with EF of 50% or higher, the hazard ratios (95% CIs) for mortality were as follows: EF of 40% to 49%, 1.4 (1.0 to 2.0); EF of 30% to 39%, 1.6 (1.2 to 2.4); EF of 20% to 29%, 1.7 (1.2 to 2.4); EF of 10% to 19%, 2.4 (1.7 to 3.3) (log-rank P≤.001). Although measures of venous valvular incompetence did not independently predict outcomes, venous disease severity assessed by CEAP score was predictive. After adjusting for several clinical covariates, both CMP EF and clinical venous disease severity assessed by CEAP score remained independent predictors of mortality.
Conclusion:
Mortality rates are higher in patients with reduced CMP EF and seem to increase with each 10% decrement in CMP EF. The mortality mechanism does not seem to be impacted by venous valvular incompetence and may represent variables intrinsic to muscular physiology.
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