Clin Res Cardiol (2021) DOI DOI https://doi.org/10.1007/s00392-021-01843-w

Improved cardiac function and arterio-ventricular coupling in patients with peripheral artery disease following peripheral intervention

G. Fuchs1, D. Messiha2, L. Halfmann1, M. Steinmetz1, T. Rassaf1, C. Rammos1

1Klinik für Kardiologie und Angiologie, Universitätsklinikum Essen, Essen; 2Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf, Düsseldorf;

Background PAD is a major manifestation of atherosclerosis and patients have high morbidity and mortality rates. Cardiac function is crucial and correlates with increased cardiovascular mortality. Vascular stiffness impairs cardiac output via arterio-ventricular (AV) coupling, and can be determined by global longitudinal strain (GLS) to (pulse wave velocity) PWV ratio.  The impact of PAD-related endovascular treatment on arterial stiffness, central hemodynamics and AV coupling has not been elucidated in depth. Purpose The aim of this study was to investigate the impact of peripheral endovascular intervention on  vascular and cardiac function  with special emphasis on AV coupling.  Methods In a single-centre crossover study we screened 83 patients suspected of having PAD requiring intervention in the peripheral arteries. GLS was determined by speckle tracking echocardiography. PWV, Augmentation Index (AIx), central blood pressure (CBP) were determined using dedicated waveform analysis. Cardiac and vascular functions were determined before and shortly after peripheral intervention.  Results  The mean age was 68 ± 9,9 years with 60% male subjects. The symptoms were clinically classified using Fontaine classification and verified by colour-coded duplex sonography.  After endovascular treatment, peripheral perfusion was enhanced (ABI 0,45±0,6 to 0,81±0,5, p<0,0001, n=83). Moreover, central hemodynamics were improved (AIx 33,7±3% to 27,9±2%, p=0,0008; AP 17,8±2 mmHg to 14,0±2 mmHg, p=0,0004; central PP 52,4±6 mmHg to 46,4±6 mmHg, p=0,0001, n=83). Impressively, left ventricular function was also significantly improved (GLS -15,7±2,3% vs -17,1±2,8%, p=0,005; n=30) with an improvement in AV coupling (PWV/GLS ratio -0,58m/sec% to -0,56m/sec%, p<0,01; n=30). Conclusions Our results demonstrate that endovascular treatment of the peripheral vessels is associated with an improvement of central hemodynamics and left ventricular function via enhanced AV coupling. These prognostic relevant markers of cardiovascular disease could point to an overall potential mortality benefit through PAD treatment. Further investigation of the underlying mechanisms of AV coupling in the setting of endovascular treatment of PAD with impact on cardiovascular mortality is needed in this high-risk population.

https://dgk.org/kongress_programme/jt2021/aP1471.html