Initial diastolic dysfunction is a powerful predictor of 5-year mortality in peripheral arterial disease patients undergoing percutaneous transluminal angioplasty

Kyung Hee Kim, Saarwaani Vallabhajosyula, Seung Woon Rha, Byoung Geol Choi, Jae Kyung Byun, Cheol Ung Choi

Research output: Contribution to journalArticlepeer-review

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/eʹ ≥ 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/eʹ ≥ 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/eʹ ≥ 15, a non-invasive estimate of left atrial filling pressure, was the only independent predictor of long-term mortality. Graphic abstract: [Figure not available: see fulltext.]

Original languageEnglish
Pages (from-to)1514-1524
Number of pages11
JournalHeart and Vessels
Volume36
Issue number10
DOIs
Publication statusAccepted/In press - 2021
Externally publishedYes

Keywords

  • Diastolic dysfunction
  • Heart failure
  • Peripheral artery disease
  • Systolic dysfunction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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