Barbara Rantner1, Johannes Pohlhammer2, Marietta Stadler3, Slobodan Peric4, Angelika Hammerer-Lercher5, Peter Klein-Weigel6, Gustav Fraedrich7, Florian Kronenberg2, Barbara Kollerits8. 1. Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria; Department of Vascular Surgery, Medical University of Innsbruck, Innsbruck, Austria. 2. Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria. 3. 3rd Medical Department of Metabolic Diseases and Nephrology, Hietzing Hospital, Vienna, Austria; Diabetes Research Team, King's College London, London, United Kingdom. 4. 3rd Medical Department of Metabolic Diseases and Nephrology, Hietzing Hospital, Vienna, Austria. 5. Central Institute for Medical and Chemical Laboratory Diagnostics, University Hospital Innsbruck, Medical University of Innsbruck, Innsbruck, Austria. 6. Clinic for Angiology, HELIOS Klinikum Berlin-Buch, Berlin, Germany. 7. Department of Vascular Surgery, Medical University of Innsbruck, Innsbruck, Austria. 8. Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria. Electronic address: Barbara.Kollerits@i-med.ac.at.
Abstract
BACKGROUND: Individuals with an impaired ventricular function have a poor prognosis due to underlying heart failure and higher mortality rates. Patients with peripheral arterial disease (PAD) represent a high-risk population for left ventricular systolic dysfunction (LVSD). METHODS: The left ventricular ejection fraction (LVEF) was measured in a subset of the CAVASIC Study, consisting of 180 male patients with intermittent claudication and 226 controls. The patients were prospectively followed for a median time of 7 years. The association of LVEF with PAD and prevalent cardiovascular disease (CVD) as well as with incident CVD and survival rates during follow-up was analyzed. RESULTS: The prevalence of LVSD (LVEF<55%) was 30% among PAD patients and 7% among controls (p < 0.001). The adjusted logistic regression analysis showed that a decrease of LVEF by one standard deviation (SD) and an LVEF below 55% was associated with PAD (OR = 1.72, 95%CI 1.30-2.28 and OR = 5.71, 95%CI 2.52-12.95, both p < 0.001). Similar results were found for prevalent CVD (n = 50) in PAD patients: LVEF per SD: OR 1.60; LVEF <55%: OR 2.81, both p ≤ 0.008. The adjustment for ln-NT-proBNP or hs-cTnT resulted in a borderline significant association. In the adjusted Cox regression analysis a decrease of LVEF by one SD showed a trend for association with all-cause mortality (n = 32) (HR 1.27, p = 0.08). An impaired LVEF significantly increased the risk for incident major CVD events (n = 52): HR 1.56, p < 0.01. CONCLUSIONS: Patients with PAD have significantly lower LVEF values compared to controls. The LVEF can serve as a risk predictor for subsequent cardiovascular disease among this high-risk population.
BACKGROUND: Individuals with an impaired ventricular function have a poor prognosis due to underlying heart failure and higher mortality rates. Patients with peripheral arterial disease (PAD) represent a high-risk population for left ventricular systolic dysfunction (LVSD). METHODS: The left ventricular ejection fraction (LVEF) was measured in a subset of the CAVASIC Study, consisting of 180 male patients with intermittent claudication and 226 controls. The patients were prospectively followed for a median time of 7 years. The association of LVEF with PAD and prevalent cardiovascular disease (CVD) as well as with incident CVD and survival rates during follow-up was analyzed. RESULTS: The prevalence of LVSD (LVEF<55%) was 30% among PAD patients and 7% among controls (p < 0.001). The adjusted logistic regression analysis showed that a decrease of LVEF by one standard deviation (SD) and an LVEF below 55% was associated with PAD (OR = 1.72, 95%CI 1.30-2.28 and OR = 5.71, 95%CI 2.52-12.95, both p < 0.001). Similar results were found for prevalent CVD (n = 50) in PAD patients: LVEF per SD: OR 1.60; LVEF <55%: OR 2.81, both p ≤ 0.008. The adjustment for ln-NT-proBNP or hs-cTnT resulted in a borderline significant association. In the adjusted Cox regression analysis a decrease of LVEF by one SD showed a trend for association with all-cause mortality (n = 32) (HR 1.27, p = 0.08). An impaired LVEF significantly increased the risk for incident major CVD events (n = 52): HR 1.56, p < 0.01. CONCLUSIONS:Patients with PAD have significantly lower LVEF values compared to controls. The LVEF can serve as a risk predictor for subsequent cardiovascular disease among this high-risk population.
Authors: Barbara Rantner; Barbara Kollerits; Johannes Pohlhammer; Marietta Stadler; Claudia Lamina; Slobodan Peric; Peter Klein-Weigel; Hannes Mühlthaler; Gustav Fraedrich; Florian Kronenberg Journal: Sci Rep Date: 2017-04-03 Impact factor: 4.379