LV diastolic dysfunction worsens LEAD outcomes

Left ventricular (LV) diastolic dysfunction increases the risk of major adverse cardiac and cerebrovascular events (MACCEs) in patients with lower extremity artery disease (LEAD), a recent study has shown.

The researchers enrolled 200 LEAD patients (mean age, 72±9 years; 66 percent male) who had undergone echocardiography. LV dysfunction was diagnosed according to the American Society of Echocardiography or European Association of Cardiovascular Imaging. The primary outcome was MACCE, defined as a composite of death, hospitalization for heart failure, stroke, or myocardial infarction. Participants were observed for an average or 32±21 months.

Thirty-one percent of patients had LV diastolic dysfunction. These patients showed a significantly higher 3-year cumulative incidence of the primary endpoint as compared with their no-dysfunction comparators (35 percent vs 23 percent; p=0.01). This was driven by the individual components of death (28 percent vs 16 percent; p=0.01) and heart failure hospitalization (10 percent vs 7 percent; p=0.01). Myocardial infarction and stroke prevalence were comparable between subgroups.

Multivariate Cox proportional hazards analysis confirmed that LV diastolic dysfunction was a significant predictor for MACCE (hazard ratio [HR], 1.96, 95 percent confidence interval [CI], 1.09–3.55; p=0.03). The same was true for critical limb ischaemia (HR, 2.52, 95 percent CI, 1.24–5.10; p=0.01).

“These findings suggest that patients with LEAD should be evaluated not only for LV systolic function but also for diastolic function in echocardiography,” said researchers.