title: Effects of Percutaneous Transluminal Angioplasty on Diastolic Function in Patients With Chronic Occlusion of Lower-Extremity Artery.
abstract: OBJECTIVE
  We investigated whether successful revascularization of total occlusion of a large lower-extremity artery is associated with improvement of left ventricular (LV) diastolic function.
  
  
  BACKGROUND
  Total occlusion of a large lower-extremity artery might affect the systemic vascular resistance and increase the afterload, because the left ventricle must work harder to eject blood into a smaller vascular bed. Chronic elevation of afterload is a cause of LV diastolic dysfunction.
  
  
  METHODS
  This is a single-center retrospective analysis of 20 patients (10 men, age 69.6 ± 12.3 years) with chronic total occlusions (CTOs) of the aorto-iliac and femoropopliteal segments who underwent a successful endovascular revascularization. Baseline and postprocedural evaluation of diastolic function was performed, and the primary endpoint was improvement in LV diastolic function, which was defined as any decrease of the baseline E/E' ratio or any increase of the baseline E' velocity after the index procedure.
  
  
  RESULTS
  There was a significant effect of successful revascularization on the E/A ratio (from 1.5 ± 1.1 to 1.0 ± 0.3; P=.046) because of a significant increase of A velocity (from 86.3 ± 30.4 cm/s to 98.3 ± 21.8 cm/s; P=.03). The E' velocity (from 7.4 ± 2.0 cm/s to 8.3 ± 2.3 cm/s; P=.07) did not show a significant increase, but there was a significant reduction in E/E' ratio (from 14.6 ± 3.9 to 12.4 ± 3.3; P=.02). Logistic regression analysis did not identify possible predictors of improvement in LV diastolic function.
  
  
  CONCLUSIONS
  Our results showed that a successful revascularization was associated with improvement in the echocardiographic parameters of LV diastolic function in patients with CTO of large lower-extremity artery, and these changes may be related to the afterload reduction.
authors.forename: Wonho
authors.initials: W
authors.lastname: Kim
authors.forename: Ramon
authors.initials: R
authors.lastname: Quesada
authors.forename: Melanie B
authors.initials: MB
authors.lastname: Schernthaner
authors.forename: Raul E
authors.initials: RE
authors.lastname: Herrera
authors.forename: Juan-Carlos
authors.initials: JC
authors.lastname: Zevallos
authors.forename: Victor N
authors.initials: VN
authors.lastname: Becerra
authors.forename: Juan M
authors.initials: JM
authors.lastname: Acuña
authors.affiliation: Miami Cardiac and Vascular Institute (MCVI), 8900 N. Kendall Drive, Miami, FL 33176 USA. barryk@baptisthealth.net.
authors.forename: Barry T
authors.initials: BT
authors.lastname: Katzen
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000379:methods; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D001783:Blood Flow Velocity; D003971:Diastole; D004452:Echocardiography / Q000379:methods; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D011184:Postoperative Period; D020127:Recovery of Function; D016896:Treatment Outcome; D014481:United States; D014655:Vascular Resistance; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology