Article Impact Level: HIGH Data Quality: STRONG Summary of Circulation: Heart Failure, 17(9). https://doi.org/10.1161/CIRCHEARTFAILURE.123.011258 Dr. Sven Baasen et al.
Points
- ventricular (LV) diastolic function in patients with peripheral artery disease (PAD) and heart failure with preserved ejection fraction (HFpEF).
- Significant peripheral hemodynamic improvements were observed post-EVT, including reduced total peripheral resistance, increased femoral artery flow, and higher ankle-brachial index.
- Aortic function improved with decreased augmentation index and pulse wave velocity, increased arterial compliance, and a reduced aortic pulsatile load.
- Improvements in LV diastolic function were noted, including increased septal and lateral e’ velocities, decreased E/e ratio, reduced LV mass index, and enhanced patient outcomes like treadmill walking distance and NYHA class.
- EVT significantly reduces aortic pulsatile load and peripheral resistance, leading to better cardiac function and overall patient outcomes in those with PAD and HFpEF.
Summary
This study investigated the effects of endovascular treatment (EVT) on left ventricular (LV) diastolic function in patients with peripheral artery disease (PAD) and heart failure with preserved ejection fraction (HFpEF). Thirty patients with symptomatic PAD and HFpEF were assessed at baseline, the day after EVT or angiography (control), and four months later. Peripheral hemodynamics were evaluated using total peripheral resistance, femoral artery flow, and ankle-brachial index, while the aortic function was measured through arterial compliance, augmentation index, and pulse wave velocity. Left ventricular parameters were analyzed using echocardiography, and patient-centered outcomes included treadmill walking distance and the New York Heart Association (NYHA) class.
Following EVT, significant improvements in peripheral hemodynamics were observed, including reduced total peripheral resistance, increased femoral artery flow, and elevated ankle-brachial index. Aortic function also improved, with a decrease in augmentation index and pulse wave velocity and increased arterial compliance, reducing aortic pulsatile load. These changes were accompanied by improvements in LV diastolic function, shown by increased septal and lateral e’ velocities and decreased E/e’ ratio and left atrial volume index. At follow-up, both LV mass index and wall thickness decreased. Furthermore, patients experienced improvements in NYHA class and treadmill walking distance.
The study concluded that EVT significantly reduces aortic pulsatile load and peripheral resistance, leading to acute and sustained improvements in LV diastolic function in patients with PAD and HFpEF. Independent factors contributing to improved LV function included augmentation index, pulse wave velocity, and arterial compliance. These findings suggest that EVT may be a practical therapeutic approach for enhancing cardiac function and overall patient outcomes in this population.
Link to the article: https://www.ahajournals.org/doi/10.1161/CIRCHEARTFAILURE.123.011258
References Baasen, S., Stern, M., Wischmann, P., Schremmer, J., Sansone, R., Spieker, M., Wolff, G., Bönner, F., Quast, C., Heiss, C., Kelm, M., & Busch, L. (2024). Endovascular treatment of flow-limiting iliofemoral stenosis improves left ventricular diastolic function in patients with hfpef by reducing aortic pulsatile load. Circulation: Heart Failure, 17(9). https://doi.org/10.1161/CIRCHEARTFAILURE.123.011258
