Abstract 17356: Ankle-Brachial Index Predicts Future Cardiovascular Events in Patients With Heart Failure With Preserved Left Ventricular Ejection Fraction
Background: Vascular dysfunction plays an important role as the extra-cardiac factor in heart failure with preserved left ventricular ejection fraction (HFPEF). Ankle brachial index (ABI), which is a noninvasive and simple method to screen peripheral artery disease (PAD), has been shown to be associated with aortic stiffness and LV diastolic function. We investigated whether ABI values could predict future cardiovascular (CV) events in HFPEF patients.
Methods: We evaluated cardiac function by using echocardiography to measure the ratio of early transmitral flow velocity to tissue Doppler early diastolic mitral annular velocity (E/e’), and assessed ABI using automatic BP wave form analyzer (form PWV/ABI) in HFPEF patients (NYHA-II, III; n=301). HFPEF patients were followed until occurring CV events (CV death, nonfatal myocardial infarction, ischemic stroke, unstable angina, HF hospitalization, or coronary revascularization).
Results: 53 patients developed the CV events (mean follow up, 20 months). ABI was significantly lower in patients with CV events than those without events (0.98±0.23 vs. 1.07±0.15, P<0.01). Prevalence of PAD defined as ABI<0.9 were similar between patients with or without CV events (21% vs. 13%, P=0.14). Kaplan-Meier analysis demonstrated a significantly higher probability of CV events in the lower ABI patients than others (a cut-off value 1.10, log rank test P<0.01) and showed a significantly higher probability of CV events in HFPEF patients with normal ABI (0.90<ABI≤1.30, n=254) (a cut-off value 1.10, log rank test, P=0.02). Multivariate Cox hazard analysis identified ABI [hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.76-0.98, P=0.02], B-type natriuretic peptide (HR 1.72, 95% CI 1.39-2.13, P<0.01), and E/e’ (HR 1.12, 95% CI 1.01-1.23, P=0.03), but not the presence of PAD, as independent predictors of the CV events. Even if patients with PAD (n=43) were excluded, this association was still significant (ABI; HR 0.66, 95% CI 0.45-0.96, P=0.03).
Conclusions: Lower ABI independently correlated with the future CV events in patients with HFPEF. The extent of generalized atherosclerosis, especially in the lower extremity arterial system, assessed by ABI could be an important component in the clinical manifestation in HFPEF.
- © 2013 by American Heart Association, Inc.