Key result
Low left ventricular ejection fraction (<40%) independently predicted a higher incidence of major cardiovascular and cerebrovascular events (HR 2.23) and major adverse limb events (HR 1.85).
Why the study?
The mechanism underlying poor prognosis in patients with lower-extremity artery disease and heart failure is unknown, prompting evaluation of the prognostic impact of LVEF after endovascular therapy.
Does low LVEF predict MACCEs and MALEs in patients with lower-extremity artery disease undergoing endovascular therapy?
Cohort (n=2,180)
Yes
Does low LVEF predict MACCEs and MALEs in patients with lower-extremity artery disease undergoing endovascular therapy?
Hazard Ratio: 2.23 (95% CI 1.63–3.03)
Absolute Event Rate: 23.9% vs 9.9%
p-value: p=<0.001
In patients with lower-extremity artery disease undergoing endovascular therapy, a reduced left ventricular ejection fraction (<40%) is an independent predictor of both major adverse cardiovascular and limb events, irrespective of symptomatic heart failure.
BACKGROUND: The mechanism underlying a poor prognosis in patients with lower-extremity artery disease (LEAD) with heart failure is unknown. We examined the prognostic impact of the left ventricular ejection fraction (LVEF) in patients with LEAD who underwent endovascular therapy (EVT). METHODS AND RESULTS: From August 2014 to August 2016, 2,180 patients with LEAD (mean age, 73.2 years; male, 71.9%) underwent EVT and were stratified into low-LVEF (LVEF <40%; n=234, 10.7%) and not-low LVEF groups. In the low- vs. not-low LVEF groups, there was a higher prevalence of heart failure (i.e., history of heart failure hospitalization or New York Heart Association functional class III or IV symptoms) (44.0% vs. 8.3%, respectively), diabetes mellitus, chronic kidney disease, below-the-knee lesion, critical limb ischemia, and incidence of major cardiovascular and cerebrovascular events (MACCEs) and major adverse limb events (MALEs) (P<0.001, all). Low LVEF independently predicted MACCEs (hazard ratio: 2.23, 95% confidence interval: 1.63-3.03; P<0.001) and MALEs (hazard ratio: 1.85, 95% confidence interval: 1.15-2.96; P=0.011), regardless of heart failure (P value for interaction: MACCEs: 0.27; MALEs: 0.52). CONCLUSIONS: Low LVEF, but not symptomatic heart failure, increased the incidence of MACCEs and MALEs. Intensive cardiac dysfunction management may improve LEAD prognosis after EVT.
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Fukino et al. (2023) conducted a cohort in Lower-extremity artery disease (LEAD) (n=2,180). Low left ventricular ejection fraction (<40%) vs. Not-low left ventricular ejection fraction (≥40%) was evaluated on Major adverse cardiovascular and cerebrovascular events (MACCEs) (HR 2.23, 95% CI 1.63-3.03, p=<0.001). Low left ventricular ejection fraction (<40%) independently predicted a higher incidence of major cardiovascular and cerebrovascular events (HR 2.23) and major adverse limb events (HR 1.85).
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