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Published on: September 22, 2020
Cardiovascular Prognosis in Limb Ischemia Patients With Heart Failure and Systolic Dysfunction Following Major
Takuma Takada1, Eiji Shibahashi2, Shun Hasegawa2
1Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan; Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan.
Insights
Major amputation (MA) in patients with chronic limb-threatening ischemia (CLTI) and heart failure with reduced ejection fraction (HFrEF) may improve cardiovascular outcomes by reducing vascular resistance. This study suggests MA could be a strategy for high-risk patients.
Area of Science:
- Cardiology
- Vascular Surgery
- Heart Failure Management
Background:
- Chronic limb-threatening ischemia (CLTI) is a severe peripheral artery disease complication often leading to amputation.
- Heart failure with reduced ejection fraction (HFrEF) significantly increases mortality risk in CLTI patients, partly due to elevated peripheral vascular resistance.
- The interplay between CLTI, HFrEF, and cardiovascular prognosis requires further investigation.
Purpose of the Study:
- To evaluate the impact of major amputation (MA) on cardiovascular (CV) prognosis in CLTI patients with HFrEF.
- To determine if MA, by potentially lowering peripheral vascular resistance, affects CV outcomes in this high-risk population.
- To compare CV events in CLTI patients with HFrEF who underwent MA versus those who did not after endovascular therapy (EVT).
Main Methods:
- Retrospective, single-center observational study of 60 CLTI patients with HFrEF (ejection fraction < 50%) who received EVT.
- Comparison of CV outcomes between patients who underwent MA (n=17) and those who did not (n=43).
- Primary endpoint: composite of CV death or heart failure hospitalization, assessed via Kaplan-Meier analysis and Cox regression.
Main Results:
- A significantly lower incidence of the composite CV endpoint was observed in the MA group (log-rank test: p=0.035).
- Adjusted analysis indicated MA was significantly associated with improved CV prognosis (Hazard Ratio: 0.19; 95% CI: 0.04-0.87).
- A trend towards decreased overall mortality was noted in the MA group, with infection as the primary cause of death in both groups.
Conclusions:
- Major amputation may be associated with reduced cardiovascular events in CLTI patients with HFrEF.
- MA could represent a definitive strategy to improve cardiovascular outcomes in this high-risk patient cohort.
- Further prospective studies are warranted to confirm these findings.
Abstract:
Chronic limb-threatening ischemia (CLTI), the severest stage of peripheral artery disease, frequently necessitates amputation. In CLTI patients, heart failure with reduced ejection fraction (HFrEF) markedly raises mortality risk, with increased peripheral vascular resistance contributing to this exacerbation. This investigation aimed to assess the impact of major amputation (MA) on the cardiovascular (CV) prognosis in CLTI patients with HFrEF by lowering peripheral vascular resistance. Conducting a retrospective, observational analysis at a single center, a total of 60 patients with CLTI and HFrEF (EF < 50%) who underwent endovascular therapy (EVT) at our institution were assessed. We compared CV outcomes in CLTI patients with HFrEF who received MA (n = 17) to those who did not (n = 43) after undergoing EVT. During the follow-up period, which median 641 (IQR: 245 to 1,734) days post-EVT, a composite primary endpoint of CV death or hospitalization for HF was observed. During the study period, 19 patients (32%) were admitted for HF or died as a consequence of CV events. Kaplan-Meier analysis revealed a significantly reduced incidence of the primary endpoint in the MA cohort (log-rank test: p = 0.035). Adjustments for age and sex showed MA was significantly linked to improved CV prognosis (HR: 0.19; 95% confidence interval: 0.04 to 0.87). A nonsignificant trend toward decreased overall mortality was noted in the MA group, with infections being the predominant cause of death across both groups. In conclusion, in CLTI patients with HFrEF, MA might be linked to reduced CV events, proposing it as a potential definitive strategy for improving CV outcomes in this high-risk population.
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