Improving risk assessment with cardiac testing in peripheral arterial disease.
OBJECTIVE
The study's objective was to evaluate the prognostic value of left ventricular ejection fraction and stress-induced ischemia during dobutamine stress echocardiography, in addition to ankle-brachial index measurements and clinical risk factors in patients with suspected or known peripheral arterial disease.


METHODS
In 852 patients with suspected or known peripheral arterial disease (mean age 63 years, 70% male), the ankle-brachial index was measured, left ventricular ejection fraction was assessed, and all patients underwent additional stress testing. Endpoints were all-cause mortality and hard cardiac events (cardiac death or nonfatal myocardial infarction).


RESULTS
During a mean follow-up of 7.6+/-4.4 years, death occurred in 288 patients (34%), and hard cardiac events occurred in 216 patients (25%). Mean left ventricular ejection fraction was 50%+/-17%, and stress-induced ischemia was observed in 352 patients (41%). In multivariate analysis with adjustment for clinical risk factors and ankle-brachial index, each 5% decrease in left ventricular ejection fraction was associated with increased all-cause mortality (hazard ratio [HR] 1.05, 95% confidence interval [CI], 1.02-1.09) and hard events (HR 1.14, 95% CI, 1.08-1.21). Stress-induced ischemia also independently predicted all-cause mortality (HR 2.01, 95% CI, 1.38-2.79) and hard events (HR 2.06, 95% CI, 1.39-3.08). Left ventricular ejection fraction and stress-induced ischemia provided incremental prognostic information over clinical data and ankle-brachial index values (P <.001).


CONCLUSIONS
Left ventricular ejection fraction and stress-induced ischemia independently predict long-term outcome and improve prognostic risk assessment, in addition to ankle-brachial index and clinical risk factors in patients with suspected or known peripheral arterial disease.
Feringa
Harm H H
HH
Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
Elhendy
Abdou
A
Karagiannis
Stefanos E
SE
Noordzij
Peter G
PG
Dunkelgrun
Martin
M
Schouten
Olaf
O
Vidakovic
Radosav
R
van Domburg
Ron T
RT
Bax
Jeroen J
JJ
Poldermans
Don
D
D000368:Aged; D015331:Cohort Studies; D025401:Echocardiography, Stress; D005260:Female; D006331:Heart Diseases / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000150:complications*; D018570:Risk Assessment