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Abstract
Peripheral artery disease (PAD) shares common clinical risk factors, for example, endothelial dysfunction, with preserved ejection fraction (LVEF) heart failure (HFpEF). Whether PAD is associated with preclinical systolic dysfunction and higher HF risk among individuals presenting preserved LVEF remains uncertain. We retrospectively included outpatients with at least one known or established cardiovascular (CV) risk factor with LVEF ≥ 50%. Patients were categorized into high risk and low risk of developing PAD (PAD vs Non-PAD) by ankle-brachial index (ABI) (≤ 0.90 or > 1.4) and further stratified based on their history of HFpEF (HFpEF vs. Non-HFpEF), resulting in the formation of four distinct strata. Preclinical systolic dysfunction was defined using dedicated speckle-tracking algorithm. A total of 2130 consecutive patients were enrolled in the study, with a median follow-up of 4.4 years. The analysis revealed a higher prevalence of high risk of developing PAD in patients with HFpEF compared to those without HFpEF (25.1% vs. 9.4%). Both high risk of developing PAD and HFpEF were independently associated with preclinical systolic dysfunction (global longitudinal strain, GLS ≥ − 18%) (odds ratio, OR: 1.38; 95% confidence interval, CI: 1.03–1.86). In comparison to patients at low risk of developing PAD without HFpEF (Non-PAD/Non-HFpEF group), those categorized as having a high risk of developing PAD with HFpEF (PAD/HFpEF group) exhibited the most impaired GLS and a heightened susceptibility to heart failure hospitalization (hazard ratio, HR: 6.51; 95% CI: 4.43–9.55), a twofold increased risk of all-cause mortality (HR: 2.01; 95% CI: 1.17–3.38), cardiovascular mortality (HR: 2.44; 95% CI: 1.08–5.51), and non-cardiovascular mortality (HR: 1.78; 95% CI: 0.82–3.84). A high risk of developing PAD was strongly linked to impaired preclinical systolic function and an increased likelihood for subsequent hospitalization for HF, all-cause mortality, CV mortality and non-CV mortality. There is a clear need for preventive strategies aimed at reducing hospitalizations for HF and mortality in this high-risk population.
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Details
1 Mackay Medical College, Department of Medicine, New Taipei City, Taiwan (GRID:grid.452449.a) (ISNI:0000 0004 1762 5613); Mackay Memorial Hospital, Division of Cardiology, Departments of Internal Medicine, Taipei, Taiwan (GRID:grid.413593.9) (ISNI:0000 0004 0573 007X); National Yang-Ming University, School of Medicine, Institute of Clinical Medicine, Taipei, Taiwan (GRID:grid.260539.b) (ISNI:0000 0001 2059 7017)
2 Mackay Medical College, Department of Medicine, New Taipei City, Taiwan (GRID:grid.452449.a) (ISNI:0000 0004 1762 5613); Mackay Memorial Hospital, Division of Cardiology, Departments of Internal Medicine, Taipei, Taiwan (GRID:grid.413593.9) (ISNI:0000 0004 0573 007X); Mackay Junior College of Medicine, Nursing, and Management, Taipei City, Taiwan (GRID:grid.507991.3) (ISNI:0000 0004 0639 3191)
3 Mackay Medical College, Department of Medicine, New Taipei City, Taiwan (GRID:grid.452449.a) (ISNI:0000 0004 1762 5613); Mackay Memorial Hospital, Division of Cardiology, Departments of Internal Medicine, Taipei, Taiwan (GRID:grid.413593.9) (ISNI:0000 0004 0573 007X); Hsinchu MacKay Memorial Hospital, Division of Cardiology, Department of Internal Medicine, Hsin-chu City, Taiwan (GRID:grid.413593.9) (ISNI:0000 0004 0573 007X)
4 Mackay Medical College, Department of Medicine, New Taipei City, Taiwan (GRID:grid.452449.a) (ISNI:0000 0004 1762 5613); Mackay Memorial Hospital, Division of Cardiology, Departments of Internal Medicine, Taipei, Taiwan (GRID:grid.413593.9) (ISNI:0000 0004 0573 007X)
5 National Yang-Ming University, School of Medicine, Institute of Clinical Medicine, Taipei, Taiwan (GRID:grid.260539.b) (ISNI:0000 0001 2059 7017); Mackay Junior College of Medicine, Nursing, and Management, Taipei City, Taiwan (GRID:grid.507991.3) (ISNI:0000 0004 0639 3191); Kaohsiung Veterans General Hospital, Department of Radiology, Kao-hsiung City, Taiwan (GRID:grid.415011.0) (ISNI:0000 0004 0572 9992); National Yang Ming Chiao Tung University, Faculty of Medicine, School of Medicine, Taipei, Taiwan (GRID:grid.260539.b) (ISNI:0000 0001 2059 7017)