Long-term outcomes in patients with critical limb ischemia and heart failure with preserved or reduced ejection fraction

Abstract

The impact of heart failure (HF) on long-term survival in patients with critical limb ischemia (CLI) has not been well described. Outcomes stratified by left ventricular ejection fraction (EF) are also unknown. A single center retrospective chart review was performed for patients who underwent treatment for CLI from 2006 to 2013. Baseline demographics, procedural data and outcomes were analyzed. HF diagnosis was based on appropriate signs and symptoms as well as results of non-invasive testing. Among 381 CLI patients, 120 (31%) had a history of HF and 261 (69%) had no history of heart failure (no-HF). Within the HF group, 74 (62%) had HF with preserved ejection fraction (HFpEF) and 46 (38%) had HF with reduced ejection fraction (HFrEF). The average EF for those with no-HF, HFpEF and HFrEF were 59±13% vs 56±9% vs 30±9%, respectively. The likelihood of having concomitant coronary artery disease (CAD) was lowest in the no-HF group (43%), higher in the HFpEF group (70%) and highest in the HFrEF group (83%) ( p=0.001). Five-year survival was on average twofold higher in the no-HF group (43%) compared to both the HFpEF (19%, p=0.001) and HFrEF groups (24%, p=0.001). Long-term survival rates did not differ between the two HF groups ( p=0.50). There was no difference in 5-year freedom from major amputation or freedom from major adverse limb events between the no-HF, HFpEF and HFrEF groups, respectively. Overall, the combination of CLI and HF is associated with poor 5-year survival, independent of the degree of left ventricular systolic dysfunction.

Prevalence of peripheral arterial disease in patients with heart failure with preserved ejection fraction

“…Our results corroborate the current recommendations for the European Society of Cardiology and European Society of Vascular Surgery (12), which emphasize the importance of establishing this diagnosis due to the independent predictive power for hospitalization and all-cause mortality in patients with HF (4,6,9,15,16,24) and a risk factor for cardiovascular events, except stroke, in those without a previous history of HF (6,19).…”

“…Evaluating the phenomenon from another perspective, Khaira KB, et al (19) investigated the prevalence of HF in patients with PAD at more advanced stages. Of the 381 patients in their study, 31% had a previous history of HF, and the majority of the patients (62%) had HFpEF.…”

One year clinical outcomes of Rutherford 6 chronic limb threatening ischemia patients undergoing lower limb endovascular revascularisation from Singapore

“…This risk is just as, if not more, pertinent in Southeast Asian populations. Overall, concomitant CLTI and CHF is associated with poor long-term survival outcomes (Khaira et al 2017 ).…”

Infrainguinal bypass under triple nerve block in patients with severely compromised left ventricular ejection fraction and chronic limb-threatening ischemia

“…Heart failure (HF) remains highly prevalent in elderly population 22,23 with nearly half of all HF cases being due to impaired LV systolic function 24 . In turn, compromised LVEF remains one of the key factors predicting perioperative mortality in noncardiac interventions [2][3][4][5][6][7][8][9][10] , particularly those performed for CLTI due to PAD [25][26][27] .…”