LEFT HEART DYSFUNCTION AND HEART VALVE DISEASE DO NOT INFLUENCE OUTCOMES AFTER LOWER LIMB REVASCULARIZATION
Autor(a) principal: | |
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Data de Publicação: | 2021 |
Outros Autores: | , , , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://doi.org/10.48750/acv.349 |
Resumo: | Introduction: Inadequate systemic perfusion as a consequence of heart disease may compromise inflow to lower limb revascularization procedures, decreasing short and mid-term patency. It may be theorized that patients suffering from heart valve disease or reduction of left ventricular ejection fraction (LVEF) have worse limb outcomes after lower limb revascularization. Method: This retrospective study included all first lower limb revascularization procedures performed in a tertiary hospital, between January 2017 and December 2018, in patients with diagnosed PAD and an available preoperative transthoracic echocardiogram (TTE). The group with moderate to severe heart disease in TTE (Group 1, defined as LVEF<40% or moderate to severe valvular heart disease) was compared against the group with no or mild heart disease in TTE (Group 2, defined as LVEF≥40% and no or mild valvular heart disease). Subgroup analysis was undertaken considering the presence and severity of the individual heart change on TTE. Primary endpoint was major amputation, and secondary endpoints were diagnosed restenosis/occlusion, vascular reintervention and overall survival. Results: The study included 268 lower limb revascularization procedures. Group 1 and 2 included 70 and 198 procedures, respectively. In both groups, the prevalence of CLTI was 89%. There were no significant differences in wound and infection grading (in WIfI), and anatomic disease staging (in GLASS), between Groups 1 and 2. In Group 1, 73% were endovascular procedures (65% in Group 2; p=0,34). Amputation rates in Group 1 and 2 were 9% and 13% at 1 month, 19% and 20% at 1 year and 19% and 22% at 2 years, respectively (p=0,758). Diagnosed restenosis/occlusion rates in Group 1 and 2 were 5% and 15% at 1 month, 18% and 26% at 1 year and 24% and 31% at 2 years, respectively (p=0,119). Reintervention rates in Group 1 and 2 were 13% and 18% at 1 month, 25% and 27% at 1 year and 30% and 32% at 2 years, respectively (p=0,614). After subgroup analysis according to the presence and severity of individual heart change, the difference remained non-significant for the above-mentioned outcomes. Overall survival in Group 1 and 2 was 92% and 96% at 1 month, 61% and 86% at 1 year and 52% and 80% at 2 years, respectively (p<0,001). LVEF<40% was associated with worse overall survival (p<0,001), as was moderate to severe valvular heart disease (p=0,004). Conclusion: Our study suggests that moderate to severe heart disease, detected in TTE, does not influence limb-related outcomes after revascularization procedures. However, patients with valvular heart disease or LVEF reduction have worse overall survival. We should not expect worse limb outcomes in patients with heart disease, but aggressive tertiary prevention should be provided to improve vital prognosis. |
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LEFT HEART DYSFUNCTION AND HEART VALVE DISEASE DO NOT INFLUENCE OUTCOMES AFTER LOWER LIMB REVASCULARIZATIONA DISFUNÇÃO DO VENTRÍCULO ESQUERDO E A DOENÇA VALVULAR CARDÍACA NÃO INFLUENCIAM OS RESULTADOS DA REVASCULARIZAÇÃO DE MEMBRO INFERIORTransthoracic Echocardiogram (TTE)Reduction of Left Ventricular Ejection Fraction (LVEF)Valvular Heart DiseasePeripheral Arterial Disease (PAD)Chronic Limb-Threatening Ischemia (CLTI)Ecocardiograma Transtorácico (ETT)Redução da Fração de Ejeção do Ventrículo Esquerdo (FEVE)Doença Valvular CardíacaDoença Arterial Periférica (DAP)Isquémia Crónica com Compromisso do Membro (ICCM)Introduction: Inadequate systemic perfusion as a consequence of heart disease may compromise inflow to lower limb revascularization procedures, decreasing short and mid-term patency. It may be theorized that patients suffering from heart valve disease or reduction of left ventricular ejection fraction (LVEF) have worse limb outcomes after lower limb revascularization. Method: This retrospective study included all first lower limb revascularization procedures performed in a tertiary hospital, between January 2017 and December 2018, in patients with diagnosed PAD and an available preoperative transthoracic echocardiogram (TTE). The group with moderate to severe heart disease in TTE (Group 1, defined as LVEF<40% or moderate to severe valvular heart disease) was compared against the group with no or mild heart disease in TTE (Group 2, defined as LVEF≥40% and no or mild valvular heart disease). Subgroup analysis was undertaken considering the presence and severity of the individual heart change on TTE. Primary endpoint was major amputation, and secondary endpoints were diagnosed restenosis/occlusion, vascular reintervention and overall survival. Results: The study included 268 lower limb revascularization procedures. Group 1 and 2 included 70 and 198 procedures, respectively. In both groups, the prevalence of CLTI was 89%. There were no significant differences in wound and infection grading (in WIfI), and anatomic disease staging (in GLASS), between Groups 1 and 2. In Group 1, 73% were endovascular procedures (65% in Group 2; p=0,34). Amputation rates in Group 1 and 2 were 9% and 13% at 1 month, 19% and 20% at 1 year and 19% and 22% at 2 years, respectively (p=0,758). Diagnosed restenosis/occlusion rates in Group 1 and 2 were 5% and 15% at 1 month, 18% and 26% at 1 year and 24% and 31% at 2 years, respectively (p=0,119). Reintervention rates in Group 1 and 2 were 13% and 18% at 1 month, 25% and 27% at 1 year and 30% and 32% at 2 years, respectively (p=0,614). After subgroup analysis according to the presence and severity of individual heart change, the difference remained non-significant for the above-mentioned outcomes. Overall survival in Group 1 and 2 was 92% and 96% at 1 month, 61% and 86% at 1 year and 52% and 80% at 2 years, respectively (p<0,001). LVEF<40% was associated with worse overall survival (p<0,001), as was moderate to severe valvular heart disease (p=0,004). Conclusion: Our study suggests that moderate to severe heart disease, detected in TTE, does not influence limb-related outcomes after revascularization procedures. However, patients with valvular heart disease or LVEF reduction have worse overall survival. We should not expect worse limb outcomes in patients with heart disease, but aggressive tertiary prevention should be provided to improve vital prognosis.Introdução: A doença cardíaca pode causar diminuição da perfusão sistémica e comprometer o inflow para procedimentos de revascularização de membro inferior, diminuindo a sua permeabilidade a curto e médio prazo. É possível que os doentes com doença valvular cardíaca ou redução da fração de ejeção do ventrículo esquerdo (FEVE) tenham piores resultados após revascularização dos membros inferiores. Métodos: Este estudo retrospetivo incluiu todos os procedimentos iniciais de revascularização de membro inferior realizados num hospital terciário, entre Janeiro de 2017 e Dezembro de 2018, em doentes com DAP diagnosticada e um ecocardiograma transtorácico (ETT) pré-operatório. O grupo com doença cardíaca moderada a grave no ETT (Grupo 1, definido como FEVE<40% ou doença valvular cardíaca moderada a grave) foi comparado com o grupo com doença cardíaca ligeira ou ausente (Grupo 2, definido como FEVE≥40% e doença valvular ligeira ou ausente). Foi realizada análise de subgrupo considerando a presença e gravidade da alteração específica no ETT. O endpoint primário foi amputação major e os endpoints secundários foram restenose/oclusão diagnosticada, reintervenção vascular e sobrevida. Resultados: O estudo incluiu 268 procedimentos de revascularização de membro inferior. Os Grupos 1 e 2 incluíram 70 e 198 procedimentos, respetivamente. A prevalência de isquémia crónica com compromisso de membro (ICCM) foi de 89% em ambos os grupos. Não se verificou diferença significativa entre os grupos na gradação de ferida e infeção (no sistema WIfI) e no estadiamento anatómico da doença (no sistema GLASS). O Grupo 1 incluiu 73% procedimentos endovasculares (65% no Grupo 2; p=0,34). As taxas de amputação nos Grupos 1 e 2 foram 9% e 13% a 1 mês, 19% e 20% a 1 ano e 19% e 22% a 2 anos, respetivamente (p=0,758). As taxas de restenose/oclusão diagnosticada nos Grupos 1 e 2 foram 5% e 15% a 1 mês, 18% e 26% a 1 ano e 24% e 31% a 2 anos, respetivamente (p=0,119). As taxas de reintervenção nos Grupos 1 e 2 foram 13% e 18% a 1 mês, 25% e 27% a 1 ano e 30% e 32% a 2 anos, respetivamente (p=0,614). Após estratificação em subgrupos de acordo com a presença e gravidade da alteração cardíaca específica, as diferenças para os outcomes acima apresentados permaneceram não significativas. A sobrevida global nos Grupos 1 e 2 foi de 92% e 96% a 1 mês, 61% e 86% a 1 ano e 52% e 80% a 2 anos, respetivamente (p<0,001). A presença de FEVE<40% associou-se a pior sobrevida (p<0,001), tal como a presença de doença valvular cardíaca moderada a grave (p=0,004). Conclusão: O nosso estudo sugere que a doença cardíaca moderada a grave, definida no ETT, não influencia os outcomes relacionados com o membro após procedimentos de revascularização. Contudo, os doentes com doença cardíaca valvular ou redução da FEVE têm pior sobrevida. Não devemos assumir que os doentes cardíacos têm piores outcomes relacionados com o membro, mas devemos providenciar prevenção terciária agressiva para melhorar o seu prognóstico vital.Sociedade Portuguesa de Angiologia e Cirurgia Vascular2021-09-10T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttps://doi.org/10.48750/acv.349oai:ojs.acvjournal.com:article/349Angiologia e Cirurgia Vascular; Vol. 17 No. 2 (2021): June; 81-87Angiologia e Cirurgia Vascular; Vol. 17 N.º 2 (2021): Junho; 81-872183-00961646-706Xreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPenghttp://acvjournal.com/index.php/acv/article/view/349https://doi.org/10.48750/acv.349http://acvjournal.com/index.php/acv/article/view/349/242Copyright (c) 2021 Angiologia e Cirurgia Vascularinfo:eu-repo/semantics/openAccessCorreia, RicardoCatarino, JoanaVieira, IsabelBento, RitaGarcia, RitaPais, FábioRibeiro, TiagoCardoso, JoanaFerreira, RitaGarcia, AnaBastos Gonçalves, FredericoFerreira, Maria Emília2022-05-23T15:10:11Zoai:ojs.acvjournal.com:article/349Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T14:57:42.272581Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
LEFT HEART DYSFUNCTION AND HEART VALVE DISEASE DO NOT INFLUENCE OUTCOMES AFTER LOWER LIMB REVASCULARIZATION A DISFUNÇÃO DO VENTRÍCULO ESQUERDO E A DOENÇA VALVULAR CARDÍACA NÃO INFLUENCIAM OS RESULTADOS DA REVASCULARIZAÇÃO DE MEMBRO INFERIOR |
title |
LEFT HEART DYSFUNCTION AND HEART VALVE DISEASE DO NOT INFLUENCE OUTCOMES AFTER LOWER LIMB REVASCULARIZATION |
spellingShingle |
LEFT HEART DYSFUNCTION AND HEART VALVE DISEASE DO NOT INFLUENCE OUTCOMES AFTER LOWER LIMB REVASCULARIZATION Correia, Ricardo Transthoracic Echocardiogram (TTE) Reduction of Left Ventricular Ejection Fraction (LVEF) Valvular Heart Disease Peripheral Arterial Disease (PAD) Chronic Limb-Threatening Ischemia (CLTI) Ecocardiograma Transtorácico (ETT) Redução da Fração de Ejeção do Ventrículo Esquerdo (FEVE) Doença Valvular Cardíaca Doença Arterial Periférica (DAP) Isquémia Crónica com Compromisso do Membro (ICCM) |
title_short |
LEFT HEART DYSFUNCTION AND HEART VALVE DISEASE DO NOT INFLUENCE OUTCOMES AFTER LOWER LIMB REVASCULARIZATION |
title_full |
LEFT HEART DYSFUNCTION AND HEART VALVE DISEASE DO NOT INFLUENCE OUTCOMES AFTER LOWER LIMB REVASCULARIZATION |
title_fullStr |
LEFT HEART DYSFUNCTION AND HEART VALVE DISEASE DO NOT INFLUENCE OUTCOMES AFTER LOWER LIMB REVASCULARIZATION |
title_full_unstemmed |
LEFT HEART DYSFUNCTION AND HEART VALVE DISEASE DO NOT INFLUENCE OUTCOMES AFTER LOWER LIMB REVASCULARIZATION |
title_sort |
LEFT HEART DYSFUNCTION AND HEART VALVE DISEASE DO NOT INFLUENCE OUTCOMES AFTER LOWER LIMB REVASCULARIZATION |
author |
Correia, Ricardo |
author_facet |
Correia, Ricardo Catarino, Joana Vieira, Isabel Bento, Rita Garcia, Rita Pais, Fábio Ribeiro, Tiago Cardoso, Joana Ferreira, Rita Garcia, Ana Bastos Gonçalves, Frederico Ferreira, Maria Emília |
author_role |
author |
author2 |
Catarino, Joana Vieira, Isabel Bento, Rita Garcia, Rita Pais, Fábio Ribeiro, Tiago Cardoso, Joana Ferreira, Rita Garcia, Ana Bastos Gonçalves, Frederico Ferreira, Maria Emília |
author2_role |
author author author author author author author author author author author |
dc.contributor.author.fl_str_mv |
Correia, Ricardo Catarino, Joana Vieira, Isabel Bento, Rita Garcia, Rita Pais, Fábio Ribeiro, Tiago Cardoso, Joana Ferreira, Rita Garcia, Ana Bastos Gonçalves, Frederico Ferreira, Maria Emília |
dc.subject.por.fl_str_mv |
Transthoracic Echocardiogram (TTE) Reduction of Left Ventricular Ejection Fraction (LVEF) Valvular Heart Disease Peripheral Arterial Disease (PAD) Chronic Limb-Threatening Ischemia (CLTI) Ecocardiograma Transtorácico (ETT) Redução da Fração de Ejeção do Ventrículo Esquerdo (FEVE) Doença Valvular Cardíaca Doença Arterial Periférica (DAP) Isquémia Crónica com Compromisso do Membro (ICCM) |
topic |
Transthoracic Echocardiogram (TTE) Reduction of Left Ventricular Ejection Fraction (LVEF) Valvular Heart Disease Peripheral Arterial Disease (PAD) Chronic Limb-Threatening Ischemia (CLTI) Ecocardiograma Transtorácico (ETT) Redução da Fração de Ejeção do Ventrículo Esquerdo (FEVE) Doença Valvular Cardíaca Doença Arterial Periférica (DAP) Isquémia Crónica com Compromisso do Membro (ICCM) |
description |
Introduction: Inadequate systemic perfusion as a consequence of heart disease may compromise inflow to lower limb revascularization procedures, decreasing short and mid-term patency. It may be theorized that patients suffering from heart valve disease or reduction of left ventricular ejection fraction (LVEF) have worse limb outcomes after lower limb revascularization. Method: This retrospective study included all first lower limb revascularization procedures performed in a tertiary hospital, between January 2017 and December 2018, in patients with diagnosed PAD and an available preoperative transthoracic echocardiogram (TTE). The group with moderate to severe heart disease in TTE (Group 1, defined as LVEF<40% or moderate to severe valvular heart disease) was compared against the group with no or mild heart disease in TTE (Group 2, defined as LVEF≥40% and no or mild valvular heart disease). Subgroup analysis was undertaken considering the presence and severity of the individual heart change on TTE. Primary endpoint was major amputation, and secondary endpoints were diagnosed restenosis/occlusion, vascular reintervention and overall survival. Results: The study included 268 lower limb revascularization procedures. Group 1 and 2 included 70 and 198 procedures, respectively. In both groups, the prevalence of CLTI was 89%. There were no significant differences in wound and infection grading (in WIfI), and anatomic disease staging (in GLASS), between Groups 1 and 2. In Group 1, 73% were endovascular procedures (65% in Group 2; p=0,34). Amputation rates in Group 1 and 2 were 9% and 13% at 1 month, 19% and 20% at 1 year and 19% and 22% at 2 years, respectively (p=0,758). Diagnosed restenosis/occlusion rates in Group 1 and 2 were 5% and 15% at 1 month, 18% and 26% at 1 year and 24% and 31% at 2 years, respectively (p=0,119). Reintervention rates in Group 1 and 2 were 13% and 18% at 1 month, 25% and 27% at 1 year and 30% and 32% at 2 years, respectively (p=0,614). After subgroup analysis according to the presence and severity of individual heart change, the difference remained non-significant for the above-mentioned outcomes. Overall survival in Group 1 and 2 was 92% and 96% at 1 month, 61% and 86% at 1 year and 52% and 80% at 2 years, respectively (p<0,001). LVEF<40% was associated with worse overall survival (p<0,001), as was moderate to severe valvular heart disease (p=0,004). Conclusion: Our study suggests that moderate to severe heart disease, detected in TTE, does not influence limb-related outcomes after revascularization procedures. However, patients with valvular heart disease or LVEF reduction have worse overall survival. We should not expect worse limb outcomes in patients with heart disease, but aggressive tertiary prevention should be provided to improve vital prognosis. |
publishDate |
2021 |
dc.date.none.fl_str_mv |
2021-09-10T00:00:00Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://doi.org/10.48750/acv.349 oai:ojs.acvjournal.com:article/349 |
url |
https://doi.org/10.48750/acv.349 |
identifier_str_mv |
oai:ojs.acvjournal.com:article/349 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
http://acvjournal.com/index.php/acv/article/view/349 https://doi.org/10.48750/acv.349 http://acvjournal.com/index.php/acv/article/view/349/242 |
dc.rights.driver.fl_str_mv |
Copyright (c) 2021 Angiologia e Cirurgia Vascular info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Copyright (c) 2021 Angiologia e Cirurgia Vascular |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Sociedade Portuguesa de Angiologia e Cirurgia Vascular |
publisher.none.fl_str_mv |
Sociedade Portuguesa de Angiologia e Cirurgia Vascular |
dc.source.none.fl_str_mv |
Angiologia e Cirurgia Vascular; Vol. 17 No. 2 (2021): June; 81-87 Angiologia e Cirurgia Vascular; Vol. 17 N.º 2 (2021): Junho; 81-87 2183-0096 1646-706X reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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RCAAP |
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RCAAP |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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