Abstract 17624: Ventricular-Arterial Coupling in Altered in Patients With Peripheral Arterial Disease and Associated With Mortality
Introduction: Peripheral arterial disease (PAD) is characterized by arterial dysfunction, which may in turn affect cardiac function. Whether ventricular-arterial coupling, a key determinant of cardiovascular performance, is altered in patients with PAD is not known.
Hypothesis: We hypothesized that ventricular-arterial coupling is altered in patients with PAD and associated with mortality.
Methods: We reviewed transthoracic echocardiography data of 1308 patients with PAD (mean age 70±10 y, 64% men, ankle brachial index ≤ 0.9) and 754 patients without PAD (mean age 60±12 y, 47% men) enrolled in a study to identify biomarkers of PAD. Ventricular-arterial coupling was quantified as the ratio of effective arterial load (Ea) to LV end-systolic elastance (Ees) and Ea further deconstructed into pulsatile load - total arterial compliance (TAC), and steady load - systemic vascular resistance. Comorbidities were ascertained using previously validated electronic medical record-based algorithms. All-cause mortality was ascertained and the association of Ea/Ees with mortality was assessed by multivariable Cox proportional hazards regression analyses.
Results: Patients with PAD had higher Ea (β±SE:0.08±0.03, P=0.02), and lower TAC (β±SE:-0.16±0.03, P<0.001), similar Ees (β±SE:-0.26±0.17, P=0.13) and higher Ea/Ees (β±SE:0.05±0.02, P=0.009), when compared to those without PAD, after adjustment for age, sex, cardiovascular risk factors and comorbidities (Table). During a median follow-up of 3.4 years (total 170 deaths), 155 PAD patients died. Higher log Ea and Ea/Ees and lower TAC (but neither pulse pressure nor systolic BP) were independent predictors of mortality in patients with PAD (all P≤0.009, Table)
Conclusions: Patients with PAD have greater total and pulsatile hemodynamic load than those without PAD, resulting in altered arterial-ventricular coupling. Ea, TAC and Ea/Ees were independent predictors of mortality in patients with PAD.
- © 2013 by American Heart Association, Inc.