The Incidence and Impact of Cardiac Function Decline after Lower Extremity Revascularization
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Published on: September 22, 2020
Yasser Jamil1, Joshua Huttler2, Dana Alameddine3
1Department of Internal Medicine, Yale School of Medicine, New Haven, CT.
Insights
Cardiac function decline after lower extremity revascularization (LER) in peripheral arterial disease (PAD) patients increases mortality but does not affect major adverse limb events (MALE). This study highlights risks for PAD patients undergoing LER.
Area of Science:
- Cardiology
- Vascular Surgery
- Medical Outcomes Research
Background:
- Peripheral arterial disease (PAD) affects limb perfusion, necessitating lower extremity revascularization (LER).
- Cardiac function decline is a potential complication post-LER, but its impact on limb outcomes is unknown.
- Major adverse limb events (MALE) are critical endpoints following LER.
Purpose of the Study:
- To investigate the association between cardiac function decline and major adverse limb events (MALE) after lower extremity revascularization (LER) in patients with peripheral arterial disease (PAD).
- To compare mortality and limb-related outcomes between patients with and without cardiac function decline post-LER.
Main Methods:
- Retrospective review of electronic health records for patients undergoing LER for PAD.
- Assessment of cardiac function using serial transthoracic echocardiograms, defining decline as a ≥10% decrease in left ventricular ejection fraction (ΔEF).
- Comparison of patient characteristics, MALE rates, reintervention, and mortality between cardiac function decline and stable cardiac function groups.
Main Results:
- Of 926 patients, 24.0% experienced cardiac function decline. These patients had higher rates of diabetes mellitus, heart failure, and periprocedural bleeding.
- Patients with cardiac function decline showed significantly higher mortality rates after a 3-year follow-up.
- Kaplan-Meier analysis indicated no significant difference in freedom from MALE or reintervention rates between the groups.
Conclusions:
- Cardiac function decline following LER in PAD patients is associated with increased overall mortality.
- Despite higher mortality, cardiac function decline does not appear to significantly impact limb-specific outcomes like MALE or reintervention rates.
- This suggests that while cardiac health is a critical factor for survival post-LER, limb salvage may be less affected by post-procedural cardiac changes.
Background:
The impact of cardiac function decline on major adverse limb events (MALE) following lower extremity revascularization (LER) in patients with peripheral arterial disease (PAD) has not been described.
Methods:
The electronic records of patients undergoing LER for PAD in a single center were reviewed. Two transthoracic echocardiograms were captured, the first within 6 months of LER and the second on later follow-up (most recent to date). Patients were then divided into 2 groups: cardiac function decline (decrease in left ventricular ejection fraction ΔEF ≥10%) or stable cardiac function (reduction in ΔEF <10%, no change or improved EF). Patient characteristics and outcomes, including MALE, were compared.
Results:
Of the 926 patients who underwent LER, 222 (24.0%) experienced a cardiac function decline, with 704 (76.0%) patients having stable cardiac function. Patients with cardiac function decline were more likely to have diabetes mellitus and heart failure than patients with stable cardiac function. There were no differences in the mode of revascularization (open vs. endovascular) between both groups. Patients with cardiac function decline demonstrated higher rates of periprocedural bleeding after initial LER. After a mean follow-up of 3 years, patients with cardiac function decline had higher mortality. However, Kaplan-Meier analysis revealed no difference in freedom from MALE or reintervention rates between the 2 groups.
Conclusions:
Patients with cardiac function decline after LER for PAD have increased mortality but no significant difference in limb outcomes compared to patients with stable cardiac function.
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