Left ventricular ejection fraction is associated with prevalent and incident cardiovascular disease in patients with intermittent claudication – results from the CAVASIC Study

Rantner, Barbara; Pohlhammer, Johannes; Stadler, Marietta; Peric, Slobodan; Hammerer-Lercher, Angelika; Klein-Weigel, Peter; Fraedrich, Gustav; Kronenberg, Florian; Kollerits, Barbara

doi:10.1016/j.atherosclerosis.2014.12.060

Cited by 14 publications

(14 citation statements)

References 39 publications

(27 reference statements)

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“…This might be due to different endpoints and different population. However, by multivariable analysis after adjustment for age, gender, BMI, Resting heart rate and LVMI, our study showed that LVEF was a significant independent predictor of cardiac-related deaths among these variables,which is consistant with other studies[ 16 – 17 ]. While peak CPO,VE/VCO 2 slope and peak VO 2 were not significant predictors of cardiac-related deaths.…”

Section: Discussionsupporting

confidence: 88%

The Prognostic Value of Peak Cardiac Power Output in Chinese Patients with Chronic Heart Failure

Shen

Song

et al. 2016

PLoS ONE

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BackgroundCardiopulmonary exercise testing has been widely used to risk stratify patients with chronic heart failure (CHF). Peak oxygen consumption (peakVO2) was regarded as a powerful predictor of survival, as it is a surrogate for peak cardiac output (CO), which by most is considered the “true” measure of heart failure. Therefore, it is reasonable to hypothesize that CO is an even stronger predictor than peak VO2. The present study is aimed to investigate the prognostic value of peak cardiac power output (peak CPO) in comparison with peakVO2 in Chinese patients with CHF.MethodsParticipants provided written informed consent to participate in this study. Totally 129 patients with CHF underwent symptom-limited cardiopulmonary exercise testing (CPET), with mean age 59.1±11.4 years, 87.6% male, 57.4% ischemic etiology, body mass index (BMI) 24.7±3.7 kg/m2 and LVEF 38±9%. CO was measured using an inert gas rebreathing method. The primary endpoints are cardiac deaths.ResultsOver median 33.7-month follow-up, 19 cardiac deaths were reported. Among peak VO2,VE/VCO2 slope and Peak CPO, their area under ROC were 0.64, 0.67, 0.68, respectively (Ρ<0.05).The optimal thresholds for predicting cardiac deaths were peak VO2≤13.4 ml.kg-1.min-1, and VE/VCO2 slope≥39.3 and peak CPO≤ 1.1 respectively by ROC analysis. Finally, in patients with a peak VO2≤13.4 ml.kg-1.min-1 those with peak CPO>1.1W had better survival than those with peak CPO ≤ 1.1W. However, by multivariate analysis adjusted for age, sex, BMI, resting heart rate, LVMI, LVEF, Peak CPO was not an independent predictor of cardiac deaths (P> 0.05).ConclusionsPeak CPO was not a predictor of cardiac death in Chinese CHF patients.

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Section: Discussionsupporting

confidence: 88%

The Prognostic Value of Peak Cardiac Power Output in Chinese Patients with Chronic Heart Failure

Shen

Song

et al. 2016

PLoS ONE

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“…From the 214 patients with symptomatic PAD still alive at the follow-up investigation1112, interviews based on a standardized questionnaire were performed at the respective medical center (n = 181) or by telephone survey where a visit in the outpatient ward was not possible (n = 3). These examinations were done by one specially trained medical doctor and one study nurse at each participating center.…”

Section: Methodsmentioning

confidence: 99%

The fate of patients with intermittent claudication in the 21st century revisited – results from the CAVASIC Study

Rantner

Kollerits

Pohlhammer

et al. 2017

Sci Rep

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Patients with intermittent claudication carry a high risk for cardiovascular complications. The TransAtlantic Inter-Society Consensus (TASC) Group estimated a five-year overall mortality of 30% for these patients, the majority dying from cardiovascular causes. We investigated whether this evaluation is still applicable in nowadays patients. We therefore prospectively followed 255 male patients with intermittent claudication from the CAVASIC Study during 7 years for overall mortality, vascular morbidity and mortality and local PAD outcomes. Overall mortality reached 16.1% (n = 41). Most patients died from cancer (n = 20). Half of patients (n = 22; 8.6%) died within the first five years. Incident cardiovascular events were observed among 70 patients (27.5%), 54 (21.2%) during the first five years. Vascular mortality was low with 5.1% (n = 13) for the entire and 3.1% for the first five years of follow-up. Prevalent coronary artery disease did not increase the risk to die from all or vascular causes. PAD symptoms remained stable or improved in the majority of patients (67%). In summary, compared to TASC, the proportion of cardiovascular events did not markedly decrease over the last two decades. Vascular mortality, however, was low among our population. This indicates that nowadays patients more often survive cardiovascular events and a major number dies from cancer.

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“…In this context it is of particular importance that PAD on its part is associated with increased severity of CAD as indicated by higher rate of multivessel and left main CAD . Heart failure is therefore more common in PAD and reduced left ventricular ejection fraction increased risk of major cardiovascular events in patients with intermittent claudication …”

Section: Introductionmentioning

confidence: 99%

“…18,19 Heart failure is therefore more common in PAD and reduced left ventricular ejection fraction increased risk of major cardiovascular events in patients with intermittent claudication. 20 The detrimental prognosis even in low-stage PAD with progression from intermittent claudication to critical limb ischemia in 21% of cases, and need of amputation in 4% to 27% of claudicants within 6 years, 21 sets focus on risk factor management as a matter of particular importance.…”

Section: Introductionmentioning

confidence: 99%

Unmet medical needs in intermittent Claudication with diabetes and coronary artery disease—A “real‐world” analysis on 21 197 PAD patients

Stalling

Engelbertz

Lüders³

et al. 2019

Clinical Cardiology

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Background Peripheral artery disease (PAD) is frequently co‐prevalent with coronary artery disease (CAD) and diabetes (DM). The study aims to define the burden of CAD and/ or DM in PAD patients at moderate stages and further to evaluate its impact on therapy and outcome. Methods Study is based on health insurance claims data of the BARMER reflecting an unselected “real‐world” scenario. Retrospective analyses were based on 21 197 patients hospitalized for PAD Rutherford 1‐3 between 1 January 2009 to 31 December 2011, including a 4‐year follow‐up (median 775 days). Results In PAD patients, CAD is prevalent in 25.3% (n = 5355), DM in 23.5% (n = 4976), and both CAD and DM in 8.2% (n = 1741). Overall, in‐hospital mortality was 0.4%, being increased if CAD was present (CAD alone: OR 1.849; 95%‐CI 1.066‐3.208; DM alone: OR 1.028; 95%‐CI 0.520‐2.033; CAD and DM: OR 3.115; 95%‐CI 1.720‐5.641). Both, CAD and DM increased long‐term mortality (CAD alone: HR 1.234; 95%‐CI 1.106‐1.376; DM alone: HR 1.260; 95%‐CI 1.125‐1.412; CAD and DM: HR 1.76; 95%‐CI 1.552‐1.995). DM further increased long‐term amputation risk (DM alone: HR 2.238; 95%‐CI 1.849‐2.710; DM and CAD: HR 2.199; 95%‐CI 1.732‐2.792), whereas CAD (alone) did not. Conclusions In a greater perspective, the data identify also mild to modest stage PAD patients at particular risk for adverse outcomes in presence of CAD and/or DM. CAD and DM both are related with a highly increased risk of long‐term mortality even in intermittent claudication, and DM independently increased amputation risk.

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Left ventricular ejection fraction is associated with prevalent and incident cardiovascular disease in patients with intermittent claudication – results from the CAVASIC Study

Cited by 14 publications

References 39 publications

The Prognostic Value of Peak Cardiac Power Output in Chinese Patients with Chronic Heart Failure

The Prognostic Value of Peak Cardiac Power Output in Chinese Patients with Chronic Heart Failure

The fate of patients with intermittent claudication in the 21st century revisited – results from the CAVASIC Study

Unmet medical needs in intermittent Claudication with diabetes and coronary artery disease—A “real‐world” analysis on 21 197 PAD patients

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