Initial diastolic dysfunction is a powerful predictor of 5-year mortality in peripheral arterial disease patients undergoing percutaneous transluminal angioplasty

Abstract

Background Peripheral arterial disease (PAD) and heart failure share common risks and are associated with increased morbidity and mortality. However, it is unknown whether cardiac function can be an independent predictor of long-term mortality in patients with PAD. Methods In total, 902 patients who underwent percutaneous transluminal angioplasty for PAD were enrolled. The patients were categorized into three groups according to the left ventricular ejection fraction (LVEF): reduced EF (< 40%, n = 62); mid-range EF (40-49%, n = 76); and preserved EF (≥ 50%, n = 764). Echocardiographic (EF, ratio of mitral in ow velocity to annular velocity E/e ≥ 15, and others) and clinical parameters were tested using stepwise logistic regression analysis to determine independent predictors of 5-year mortality. Results A higher proportion of patients with reduced EF had ischemic heart disease than those with preserved EF (77.4% vs. 56.8%, p < 0.001). Up to 5 years, patients with reduced EF and mid-range EF showed a higher incidence of total death than those with normal EF. However, there was no difference in the incidence of myocardial infarction, stroke, and revascularization among the three groups. After multivariable adjustment, the ratio of E/e ≥ 15 was the only strong predictor of total mortality (hazard ratio, 6.14; 95% con dence interval, 3.7-10.1;p < 0.01). Conclusion Patients with PAD and reduced EF undergoing PTA had a higher incidence of total death during the 5-year follow-up. Initial tissue Doppler E/e ≥ 15, a non-invasive estimate of left atrial lling pressure, was the only independent predictor of long-term mortality.

Increased Renal Medullary NOX-4 in Female but Not Male Mice during the Early Phase of Type 1 Diabetes: Potential Role of ROS in Upregulation of TGF-β1 and Fibronectin in Collecting Duct Cells

“…This suggests that blood pressure is not affected during the early stages of type I DM. Despite this observation, a direct effect of diabetic disease on blood pressure has been demonstrated in women [ 22 , 23 , 24 , 25 ]. By measuring systolic blood pressure using tail-cuff method, Islam et al found that systolic blood pressure was increased 30 days post STZ injection [ 26 ].…”