The American Journal of Medicine
Volume 120, Issue 6 , Pages 531-538, June 2007

Improving Risk Assessment with Cardiac Testing in Peripheral Arterial Disease

  • Harm H.H. Feringa, MD

      Affiliations

    • Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
    • ,
  • Abdou Elhendy, MD

      Affiliations

    • Department of Internal Medicine, Section of Cardiology, University of Nebraska, Omaha
    • ,
  • Stefanos E. Karagiannis, MD

      Affiliations

    • Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
    • ,
  • Peter G. Noordzij, MD

      Affiliations

    • Department of Anaesthesiology, Erasmus Medical Center, Rotterdam, the Netherlands
    • ,
  • Martin Dunkelgrun, MD

      Affiliations

    • Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
    • ,
  • Olaf Schouten, MD

      Affiliations

    • Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
    • ,
  • Radosav Vidakovic, MD

      Affiliations

    • Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
    • ,
  • Ron T. van Domburg, PhD

      Affiliations

    • Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
    • ,
  • Jeroen J. Bax, MD

      Affiliations

    • Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
    • ,
  • Don Poldermans, MD

      Affiliations

    • Department of Anaesthesiology, Erasmus Medical Center, Rotterdam, the Netherlands
    • Corresponding Author InformationRequests for reprints should be addressed to Don Poldermans, MD, Erasmus MC, University of Rotterdam, Department of Anaesthesiology, Room H-921, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands.

published online 25 April 2007.

Abstract 

Purpose

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.

Keywords: Ankle-brachial index, Coronary artery disease, Dobutamine stress echocardiography, Left ventricular dysfunction, Peripheral arterial disease, Prognosis

 

PII: S0002-9343(06)00892-8

doi:10.1016/j.amjmed.2006.06.041

The American Journal of Medicine
Volume 120, Issue 6 , Pages 531-538, June 2007

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