Arterial stiffness predicts amputation and death in patients with chronic limb-threatening ischemia.
Arterial stiffness indices predict cardiovascular outcomes in patients with coronary or kidney disease; however, there is little data on the prognostic value of arterial stiffness in patients with advanced peripheral arterial disease. We determined whether arterial stiffness indices predict the outcomes of major amputation or death in patients with chronic limb-threatening ischemia.Arterial stiffness was prospectively measured using brachial oscillometry in patients with chronic limb-threatening ischemia. After measuring arterial stiffness, patients were followed in 6-month intervals for up to 3 years and evaluated for limb preservation, occurrence of major amputation or death. Hemodynamic variables and arterial stiffness indices were used to define predictors of amputation or death.A total of 136 patients presented with chronic limb-threatening ischemia and 134 (99%) of these patients required limb revascularization. At the end of follow up (mean 14 months), 24 (18%) were alive with a major amputation and mortality was 7% (9 patients); 33 (24%) patients progressed to the combined outcome of major amputation or death. Patients having amputation and/or death (n=33, 24%) initially presented with elevated pulse wave velocity (13.41 ± 1.21 m/s vs 11.54 ± 1.65 m/s, p<0.001), elevated augmentation index corrected to 75 beats per minute (40.42 ± 6.65% vs 27.12 ± 9.19%, p<0.001) and high augmentation pressure (29.98 ± 4.32 mmHg vs 13.40 ± 7.05 mmHg, p<0.001) compared to patients with preserved limbs. The initial ankle-brachial index was lower in patients having amputation and/or death (0.43 ± 0.94 vs 0.62 ± 0.12; p<0.001). Multivariable analysis identified pulse wave velocity (odds ratio = 2.62; p=0.013), augmentation pressure (odds ratio = 1.56; p<0.001) and ankle-brachial index (odds ratio = 0.01; p<0.001) as predictors of amputation or death. ROC analysis identified patients with pulse wave velocity ≤ 12.7 m/s (hazard ratio = 4.71; p<0.001), augmentation pressure ≤ 22.15 mmHg (hazard ratio = 13.03; p<0.001) or ABI > 0.52 with an increased rate of limb preservation.Pulse wave velocity and augmentation pressure, measurements of arterial stiffness, as well as the ABI, predict amputation or death in patients with chronic limb-threatening ischemia.
Authors: Daniel Mendes-Pinto, Maria da Glória Rodrigues-Machado, Gustavo Laranjo Avelar, Túlio Pinho Navarro, Alan Dardik