Key result
Combined PAD and CAD is linked to higher exercise limitation and ~62% prevalence of chronotropic incompetence.
Why the study?
The mechanisms underlying effort intolerance in patients with peripheral arterial disease remained to be explored using combined stress echocardiography and CPET.
What are the physiological mechanisms of effort intolerance in patients with peripheral arterial disease when assessed by combined stress echocardiography and CPET?
Cross-Sectional (n=62)
What are the physiological mechanisms of effort intolerance in patients with peripheral arterial disease when assessed by combined stress echocardiography and CPET?
Effort intolerance in patients with peripheral arterial disease is multifactorial, driven by a combination of diastolic dysfunction, chronotropic incompetence, and impaired peripheral oxygen extraction.
May explain effort intolerance in combined PAD+CAD; hypothesis-generating for targeted interventions in prospective studies.
Aim: We used a combined stress echocardiography and cardiopulmonary exercise test (CPET) to explore effort intolerance in peripheral arterial disease (PAD) patients. Methods: Twenty-three patients who had both PAD and coronary artery disease (CAD) were compared with twenty-four sex- and age-matched CAD patients and fifteen normal controls using a symptom-limited ramp bicycle CPET on a tilting dedicated ergometer. Echocardiographic images were obtained concurrently with gas exchange measurements along predefined stages of exercise. Oxygen extraction was calculated using the Fick equation at each activity level. Results: Along the stages of exercise (unloaded; anaerobic threshold; peak), in PAD + CAD patients compared with CAD or controls, diastolic function worsened (p = 0.051 and p = 0.013, respectively), and oxygen consumption (p < 0.001 and p < 0.001, respectively) and oxygen pulse (p = 0.0024 and p = 0.0027, respectively) were reduced. Notably, oxygen pulse was blunted due to an insufficient increase in both stroke volume (p = 0.025 and p = 0.028, respectively) and peripheral oxygen extraction (p = 0.031 and p = 0.038, respectively). Chronotropic incompetence was more prevalent in PAD patients and persisted after correction for beta-blocker use (62% vs. 42% and 11%, respectively). Conclusions: In PAD patients, exercise limitation is associated with diastolic dysfunction, chronotropic incompetence and peripheral factors.
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Ghantous et al. (2023) conducted a cross-sectional in Peripheral Arterial Disease and Coronary Artery Disease (n=62). Peripheral and Coronary Artery Disease (PAD + CAD) vs. Coronary Artery Disease (CAD) alone and Normal Controls was evaluated on Chronotropic incompetence (p=0.038 vs CAD; <0.001 vs controls). Patients with combined peripheral arterial and coronary artery disease exhibited significant exercise limitation driven by worsened diastolic function, reduced oxygen consumption, and a higher prevalence of chronotropic incompetence (62% vs 42% in CAD patients and 11% in normal controls).
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