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Palliative Outpatient Inotrope in End Stage Heart Failure Patients is Safe with Moderate Survival Benefit: A Single Center Retrospective Study
The 23rd Annual Scientific Meeting HFSA
S45
Clinical Care 110
112
Role of Riociguat in Treatment of Exercise-Induced Pulmonary Hypertension Sherif T.H. Abuserewa, Ahmed M.A. Selim, Adam F. Burdorf, Douglas A. Stoller, Marshall P. Hyden, Brian D. Lowes, Ronald Zolty; University of Nebraska Medical Center, Omaha, NE
Role of Selexipag in COPD Patients with out of Proportion Pulmonary Hypertension Sherif T.H. Abuserewa, Ahmed M.A. Selim, Brian D. Lowes, Adam F. Burdorf, Douglas A. Stoller, Marshall P. Hyden, Ronald Zolty; University of Nebraska Medical Center, Omaha, NE
Background: Exercise-induced pulmonary hypertension (EiPH) can cause a significant deterioration in quality of life as well as a decrease in life expectancy. Additionally, EiPH may precede the development of manifest PH in a proportion of patients. In this study, we evaluated the effect of riociguat on the functional capacity of patients with EiPH. Hypothesis: Riociguat improves 6-minute walk test in patients with exercise-induced pulmonary hypertension. Methods: We reviewed the medical records of patients who were started on riociguat for exercise induced pulmonary hypertension. All patients had a right heart catheterization done at baseline that showed normal pulmonary hemodynamics (mPAP < 20 mmHg and PVR < 3 Wood units) with an evidence of exercise induced pulmonary hypertension (mPAP >30 mmHg, PVR> 3 Wood units at maximum arm exercise). All patients had a baseline 6-minute walk test, and a repeat test at 6 months (+/ 2 months) after starting riociguat. Results: Out of the nine patients included in this study, seven patients showed improvement of 6-minute walk distance (from 891 feet to 1197 feet, mean change 306 feet). One patient showed worsening of 6MWT (from 991 feet to 905 feet) and one patient did not show any significant change from baseline. Conclusions: In this case series of patients with exercise induced pulmonary hypertension, the use of riociguate was associated with an improvement in the functional status of patients with EiPH at 6 months. Larger size prospective studies are needed to confirm the findings.
Background: Pulmonary hypertension (PH) in patients with COPD is associated with an increase in the risk of COPD exacerbation, increased hospitalization and worse survival in this patient population. The majority of patients with COPD have a mild degree of pulmonary hypertension (with mean pulmonary artery pressure, mPAP < 35 mmHg), however higher degrees of PH, also known as out-of-proportion PH, are seen in less that 5% of patients and signal the development of an intrinsic pulmonary vascular pathology. This study evaluates the role of selexipag in treatment of out of proportion pulmonary hypertension in COPD patients. Hypothesis: Selexipag improves functional capacity in COPD patients with out of proportion pulmonary hypertension. Methods: We reviewed the medical records of COPD patients who were started on selexipag for out of proportion pulmonary hypertension. The patients were diagnosed with COPD according to their history, pulmonary function tests and chest imaging. All patients had a right heart catheterization done at baseline that showed pulmonary hypertension with mPAP 35 mmHg at rest. Six-minute walk test was done at baseline and repeated at 6 months (+/- 2 months) after starting selexipag. Results: Out of the six patients included in this study, five patients showed improvement of 6-minute walk distance (from 512 feet to 681 feet, mean change 169 feet) while 1 patient worsened (from 1177 feet to 913 feet). Conclusions: In this case series of COPD patients with out of proportion pulmonary hypertension, the use of selexipag was associated with an improvement in functional status at 6 months. Larger size prospective studies are needed to confirm the findings.
111 Predictors of Left Ventricular Systolic Dysfunction in Patients with Left Bundle Breach Block Mohamed Abdelrahman1, Yaniv Gura1, Niral Patel1, Khalil Murad2; 1Department of Internal Medicine, Case Western Reserve University / MetroHealth Medical Center, Cleveland, OH; 2Heart and Vascular Center, Case Western Reserve University / MetroHealth Medical Center, Cleveland, OH Background: Left bundle branch block (LBBB) is associated with asynchronous left ventricular (LV) activation, which may lead to left ventricular systolic dysfunction (LVSD). However, it is unknown who among patients with LBBB develops LVSD or the time it takes for LVSD to develop. The aim of this study was to identify risk factors of developing LVSD in patients with LBBB. Methods: Using electronic medical records at Metrohealth Medical Center, we identified all patients (age 18 years and older) between 01/01/2012 and 12/31/2012 who had the following: LBBB and 2 separate left ventricular ejection fraction (LVEF) assessments, with initial LVEF being normal. Using subsequent LVEF assessment (done at least 12 months later) we divided the study cohort into 2 groups (those with LVSD (LVEF < 45%) and those without LVSD (LVEF 45%). Various clinical variables such as age, sex, smoking, and the presence of key comorbidities were compared between the 2 groups. Results: Among 450 patients identified as having LBBB between 01/01/2012 and 12/31/2012, 143 patients met the inclusion criteria (mean age 65.9 +/- 13.1), 43.56 % were males. There were 64 patients (44.7%) who developed LVSD on subsequent LVEF assessment. The average drop in LVEF was 21.86% from 56.94% +/ 6.59 to 35.08% +/ 8.97. History of Hypertension was significantly associated with increased risk of developing LVSD (Odds ratio 3.2 (CI 1.12 -9.33; P=0.030), while history of coronary artery disease was significantly associated with reduced risk of developing LVSD (Odds ratio 0.23 (CI 0.13 - 0.52; P=0.0001)). Conclusions: Our results indicate that a significant proportion of patients with LBBB go on to develop LVSD. We found that hypertension increases the risk of LVSD while coronary artery disease reduces the risk of LVSD in patients with LBBB.
113 Palliative Outpatient Inotrope in End Stage Heart Failure Patients is Safe with Moderate Survival Benefit: A Single Center Retrospective Study Sujeen Adhikari1, Ambar Andrade2, Kathleen Kamba2, Muhammad Khan1, Sheraz Hussain1, Tareq Al-Saadi1, Candice Gunderson2, Sharon Brennan2, Gregory Macaluso2, Sunil Pauwaa2, Anjali Joshi2, Christopher Sciamanna2, Patroklos Pappas2, Antone Tatooles2, William Cotts2; 1UIC-Christ, Oak Lawn, IL; 2Advocate Christ Medical Center, Oak Lawn, IL Introduction: With the advent of newer heart failure (HF) medications and devices such as implantable cardioverter-defibrillator (ICD), the survival benefits of longterm intravenous (IV) inotropes might be underestimated. 1-year mortality from outpatient IV inotropes (continuous and intermittent) have been reported between 25% to 47.6%. However, a study solely based on outpatient continuous inotropes for palliation has not been done in the past. This study hypothesizes that the survival rate of patients with end stage HF on palliative intravenous inotrope is better than previously expected (6 months) and may be a viable option for certain patients. Methods and Results: We performed a single-center, retrospective chart review of HF patients who were discharged with an inotrope (milrinone or dobutamine) for palliation. Inclusion criteria included age > 18, diagnosis of HF, and patients discharged on inotropes after January 1, 2010. Exclusion criteria included patients who had received mechanical circulatory support (MCS) or patients who had received a heart transplant. Data were collected on 119 patients from the existing database of the Advocate Christ Medical Center’s heart failure clinic. Primary outcome was survival on inotropes. Secondary outcomes included number of hospitalizations, number of clinic visits, infection rates and incidence of arrhythmia on inotrope. SAS software was used for statistical analysis. 87.38% of patients were discharged on Milrinone whereas 13.51% were discharged on dobutamine. Demographics, comorbidities, medications and devices are shown in table 1. The mean follow-up time was 255.36§23.93 days.
S46 Journal of Cardiac Failure Vol. 25 No. 8S August 2019 27.03% were alive on inotrope, 15.32% were alive but weaned off of inotrope, 18.92% were on hospice, 17.12% had expired, and 21.62% were lost to follow-up. Using product-limiting survival estimates, the unconditional probability of surviving beyond 6.5 months was 84%. Mean number of hospitalizations after discharge on inotrope was 1.92§0.25. Mean number of clinic visits in 3, 6 and 12 months were 2.61§ 0.26, 4.48§0.49, 7.92§0.95 respectively. The rate of peripherally inserted central catheter infection and arrhythmia were 8.11% and 9.91% respectively. Conclusions: Palliative inotrope after diagnosis of end-stage heart failure is a safe option with moderate survival benefit in patients who opt out of or who do not meet criteria for MCS or transplant.
normal RV function, p-value 0.6417. There were no differences in LOS between both groups 8.8 § 5.6 days vs. 6.87§ 4.3 days p-value 0.1092. There were no differences in 30-day readmission rate in patients with RVD 2/24 (8.3%) vs. patients with normal RV function 44/385 (11.4%), p-value 1.000. A multivariable logistic regression that included age, sex, surgical approach, HFrEF, Pro-BNP, albumin, BAV, AKI, and RVD demonstrated that post-procedure AKI (p < 0.001) and RVD (p-0.010) are strongly associated with 1-year mortality. Conclusion: RVD is frequently associated with HFrEF in patients undergoing TAVR. However, it is an independent predictor of one-year mortality in this patient population.
Table 1. Baseline demographics of the subjects.
115 The Prevalence, Clinical Characteristics, and Functional Significance of Ankle Brachial Index Defined Peripheral Arterial Disease in Patients with Heart Failure Javier Amione-Guerra, Anand Prasad; UT Health Science Center San Antonio, San Antonio, TX
114 Long-Term Outcomes in Patients with Perioperative Right Ventricular Dysfunction Undergoing Transcatheter Aortic Valve Replacement Jesus E. Pino1, Fergie J. Ramos Tuarez1, Julio Grajeda Chavez1, Samineh Sehatbakhsh1, Pedro Torres2, Gustavo Avila Amat1, Robert Chait1, Baher S. Al Abbasi1, Edwin Grajeda1, Robert Chait1; 1University of Miami/ JFK Medical Center, West Palm Beach, FL; 2University of Miami/ JFK Medical Center, Atlantis, FL Background: Right ventricular dysfunction (RVD) has been associated with worst long-term outcome in patients undergoing surgical aortic valve replacement (SAVR). However, there are conflicting data about the long-term consequences of RVD in patients undergoing TAVR. Purpose: To evaluate the long-term outcomes of perioperative RVD in patients with severe aortic undergoing TAVR. Methods: This is a retrospective cohort study of patients that underwent TAVR in a tertiary cardiovascular center. Right ventricular function was evaluated in the perioperative period (within seven days post-TAVR period) allowing for improvement on left ventricular and right ventricular function after releasing the LVOT obstruction. RV function was dichotomized into two groups for this retrospective analysis. Evaluated outcomes included 30-day mortality, 1-year mortality, hospital stay (LOS), acute kidney injury (AKI), and 30-day readmission rate. Results: A total of 409 patients were included in the analysis. Out of 409 patients, 180 (44%) were female with a mean age of 84.6 § 6.7 years; their mean society of thoracic surgeon score (STS) was 6.4 §3.8. Transfemoral approach was performed in 313 (77%) patients. A total of 24/409 patients had right ventricular failure within seven days post-TAVR. Please, see table 1 for baseline characteristics. In patients with RVD, one-month mortality occurred in 3/24 (12.5%) patients vs. 19/385 (4.94) in patients with normal right ventricular function p-value 0.1307. One-year mortality was higher in patients with RVD 9/24 (37%) vs. 60 (15%) for patients with normal RV function p-value 0.0103. Post TAVR acute kidney injury was present in 8/24 (33%) patients with RVD vs. 108/385 (28%) for patients with
Background: The prevalence and impact of lower extremity peripheral arterial disease (PAD) in patients with heart failure (HF) remains unclear. The purpose of this study was to prospectively examine the prevalence and clinical characteristics associated with PAD defined by the ankle brachial index (ABI) in an outpatient cohort of HF patients. Methods: Clinical history, laboratory, and echocardiographic data were collected prospectively. Subjects underwent ABI measurement with calculation of both the ABI-HI (highest pedal pressure/highest brachial pressure) and ABI-LO (lowest pedal pressure/ highest brachial pressure). Subjects also underwent a 6-MWD, sit to stand test, and quality of life questionnaires (QoL). Results: A total of 103 patients were included. Abnormal ABI-LO and ABI-HI were identified in 28 (27%) and 16 (16%) of the patients, respectively. The average 6MWD was 387mts. By ABI-LO 24(23%) subjects had an ABI0.9 and 4(4%) had an ABI>1.4. Using ABI-HI 9(9%) had an ABI0.9 and 7(7%) had an ABI>1.4 An ABI-HI0.9 was more common in those with claudication (16% v. 3%, p=0.02). After adjusting for age and gender, the presence of neuropathy(OR:3.55, 95%CI:1.23-10.22), cardiomyopathy (ischemic vs non-ischemic; OR:3.10,95%CI:1.039.28), and worse NYHA class (OR:2.41, 95%CI:1.21-4.80) were associated with an abnormal ABI-LO. Conversely, in a model adjusted for age and gender, eGFR(OR:0.96, 95%CI:0.94-0.99) and peripheral neuropathy (OR:6.70, 95%CI:1.76-25.48) were significantly associated with an abnormal ABI-HI. ABI-LO but not ABI-HI was correlated with 6MWD<387m; after adjusting for age, both a history of prior CABG and ABI-LO0.9 remained independently associated with 6MWD. There was no association of ABIs with QoL. Conclusions: PAD may be as high as 27% in the ambulatory HF population and vary by calculation method. Ischemia, worsening HF, and eGFR were commonly associated with abnormal ABIs. ABIs had a small but significant correlation with 6-MWD but not of quality of life scores.
S45
Clinical Care 110
112
Role of Riociguat in Treatment of Exercise-Induced Pulmonary Hypertension Sherif T.H. Abuserewa, Ahmed M.A. Selim, Adam F. Burdorf, Douglas A. Stoller, Marshall P. Hyden, Brian D. Lowes, Ronald Zolty; University of Nebraska Medical Center, Omaha, NE
Role of Selexipag in COPD Patients with out of Proportion Pulmonary Hypertension Sherif T.H. Abuserewa, Ahmed M.A. Selim, Brian D. Lowes, Adam F. Burdorf, Douglas A. Stoller, Marshall P. Hyden, Ronald Zolty; University of Nebraska Medical Center, Omaha, NE
Background: Exercise-induced pulmonary hypertension (EiPH) can cause a significant deterioration in quality of life as well as a decrease in life expectancy. Additionally, EiPH may precede the development of manifest PH in a proportion of patients. In this study, we evaluated the effect of riociguat on the functional capacity of patients with EiPH. Hypothesis: Riociguat improves 6-minute walk test in patients with exercise-induced pulmonary hypertension. Methods: We reviewed the medical records of patients who were started on riociguat for exercise induced pulmonary hypertension. All patients had a right heart catheterization done at baseline that showed normal pulmonary hemodynamics (mPAP < 20 mmHg and PVR < 3 Wood units) with an evidence of exercise induced pulmonary hypertension (mPAP >30 mmHg, PVR> 3 Wood units at maximum arm exercise). All patients had a baseline 6-minute walk test, and a repeat test at 6 months (+/ 2 months) after starting riociguat. Results: Out of the nine patients included in this study, seven patients showed improvement of 6-minute walk distance (from 891 feet to 1197 feet, mean change 306 feet). One patient showed worsening of 6MWT (from 991 feet to 905 feet) and one patient did not show any significant change from baseline. Conclusions: In this case series of patients with exercise induced pulmonary hypertension, the use of riociguate was associated with an improvement in the functional status of patients with EiPH at 6 months. Larger size prospective studies are needed to confirm the findings.
Background: Pulmonary hypertension (PH) in patients with COPD is associated with an increase in the risk of COPD exacerbation, increased hospitalization and worse survival in this patient population. The majority of patients with COPD have a mild degree of pulmonary hypertension (with mean pulmonary artery pressure, mPAP < 35 mmHg), however higher degrees of PH, also known as out-of-proportion PH, are seen in less that 5% of patients and signal the development of an intrinsic pulmonary vascular pathology. This study evaluates the role of selexipag in treatment of out of proportion pulmonary hypertension in COPD patients. Hypothesis: Selexipag improves functional capacity in COPD patients with out of proportion pulmonary hypertension. Methods: We reviewed the medical records of COPD patients who were started on selexipag for out of proportion pulmonary hypertension. The patients were diagnosed with COPD according to their history, pulmonary function tests and chest imaging. All patients had a right heart catheterization done at baseline that showed pulmonary hypertension with mPAP 35 mmHg at rest. Six-minute walk test was done at baseline and repeated at 6 months (+/- 2 months) after starting selexipag. Results: Out of the six patients included in this study, five patients showed improvement of 6-minute walk distance (from 512 feet to 681 feet, mean change 169 feet) while 1 patient worsened (from 1177 feet to 913 feet). Conclusions: In this case series of COPD patients with out of proportion pulmonary hypertension, the use of selexipag was associated with an improvement in functional status at 6 months. Larger size prospective studies are needed to confirm the findings.
111 Predictors of Left Ventricular Systolic Dysfunction in Patients with Left Bundle Breach Block Mohamed Abdelrahman1, Yaniv Gura1, Niral Patel1, Khalil Murad2; 1Department of Internal Medicine, Case Western Reserve University / MetroHealth Medical Center, Cleveland, OH; 2Heart and Vascular Center, Case Western Reserve University / MetroHealth Medical Center, Cleveland, OH Background: Left bundle branch block (LBBB) is associated with asynchronous left ventricular (LV) activation, which may lead to left ventricular systolic dysfunction (LVSD). However, it is unknown who among patients with LBBB develops LVSD or the time it takes for LVSD to develop. The aim of this study was to identify risk factors of developing LVSD in patients with LBBB. Methods: Using electronic medical records at Metrohealth Medical Center, we identified all patients (age 18 years and older) between 01/01/2012 and 12/31/2012 who had the following: LBBB and 2 separate left ventricular ejection fraction (LVEF) assessments, with initial LVEF being normal. Using subsequent LVEF assessment (done at least 12 months later) we divided the study cohort into 2 groups (those with LVSD (LVEF < 45%) and those without LVSD (LVEF 45%). Various clinical variables such as age, sex, smoking, and the presence of key comorbidities were compared between the 2 groups. Results: Among 450 patients identified as having LBBB between 01/01/2012 and 12/31/2012, 143 patients met the inclusion criteria (mean age 65.9 +/- 13.1), 43.56 % were males. There were 64 patients (44.7%) who developed LVSD on subsequent LVEF assessment. The average drop in LVEF was 21.86% from 56.94% +/ 6.59 to 35.08% +/ 8.97. History of Hypertension was significantly associated with increased risk of developing LVSD (Odds ratio 3.2 (CI 1.12 -9.33; P=0.030), while history of coronary artery disease was significantly associated with reduced risk of developing LVSD (Odds ratio 0.23 (CI 0.13 - 0.52; P=0.0001)). Conclusions: Our results indicate that a significant proportion of patients with LBBB go on to develop LVSD. We found that hypertension increases the risk of LVSD while coronary artery disease reduces the risk of LVSD in patients with LBBB.
113 Palliative Outpatient Inotrope in End Stage Heart Failure Patients is Safe with Moderate Survival Benefit: A Single Center Retrospective Study Sujeen Adhikari1, Ambar Andrade2, Kathleen Kamba2, Muhammad Khan1, Sheraz Hussain1, Tareq Al-Saadi1, Candice Gunderson2, Sharon Brennan2, Gregory Macaluso2, Sunil Pauwaa2, Anjali Joshi2, Christopher Sciamanna2, Patroklos Pappas2, Antone Tatooles2, William Cotts2; 1UIC-Christ, Oak Lawn, IL; 2Advocate Christ Medical Center, Oak Lawn, IL Introduction: With the advent of newer heart failure (HF) medications and devices such as implantable cardioverter-defibrillator (ICD), the survival benefits of longterm intravenous (IV) inotropes might be underestimated. 1-year mortality from outpatient IV inotropes (continuous and intermittent) have been reported between 25% to 47.6%. However, a study solely based on outpatient continuous inotropes for palliation has not been done in the past. This study hypothesizes that the survival rate of patients with end stage HF on palliative intravenous inotrope is better than previously expected (6 months) and may be a viable option for certain patients. Methods and Results: We performed a single-center, retrospective chart review of HF patients who were discharged with an inotrope (milrinone or dobutamine) for palliation. Inclusion criteria included age > 18, diagnosis of HF, and patients discharged on inotropes after January 1, 2010. Exclusion criteria included patients who had received mechanical circulatory support (MCS) or patients who had received a heart transplant. Data were collected on 119 patients from the existing database of the Advocate Christ Medical Center’s heart failure clinic. Primary outcome was survival on inotropes. Secondary outcomes included number of hospitalizations, number of clinic visits, infection rates and incidence of arrhythmia on inotrope. SAS software was used for statistical analysis. 87.38% of patients were discharged on Milrinone whereas 13.51% were discharged on dobutamine. Demographics, comorbidities, medications and devices are shown in table 1. The mean follow-up time was 255.36§23.93 days.
S46 Journal of Cardiac Failure Vol. 25 No. 8S August 2019 27.03% were alive on inotrope, 15.32% were alive but weaned off of inotrope, 18.92% were on hospice, 17.12% had expired, and 21.62% were lost to follow-up. Using product-limiting survival estimates, the unconditional probability of surviving beyond 6.5 months was 84%. Mean number of hospitalizations after discharge on inotrope was 1.92§0.25. Mean number of clinic visits in 3, 6 and 12 months were 2.61§ 0.26, 4.48§0.49, 7.92§0.95 respectively. The rate of peripherally inserted central catheter infection and arrhythmia were 8.11% and 9.91% respectively. Conclusions: Palliative inotrope after diagnosis of end-stage heart failure is a safe option with moderate survival benefit in patients who opt out of or who do not meet criteria for MCS or transplant.
normal RV function, p-value 0.6417. There were no differences in LOS between both groups 8.8 § 5.6 days vs. 6.87§ 4.3 days p-value 0.1092. There were no differences in 30-day readmission rate in patients with RVD 2/24 (8.3%) vs. patients with normal RV function 44/385 (11.4%), p-value 1.000. A multivariable logistic regression that included age, sex, surgical approach, HFrEF, Pro-BNP, albumin, BAV, AKI, and RVD demonstrated that post-procedure AKI (p < 0.001) and RVD (p-0.010) are strongly associated with 1-year mortality. Conclusion: RVD is frequently associated with HFrEF in patients undergoing TAVR. However, it is an independent predictor of one-year mortality in this patient population.
Table 1. Baseline demographics of the subjects.
115 The Prevalence, Clinical Characteristics, and Functional Significance of Ankle Brachial Index Defined Peripheral Arterial Disease in Patients with Heart Failure Javier Amione-Guerra, Anand Prasad; UT Health Science Center San Antonio, San Antonio, TX
114 Long-Term Outcomes in Patients with Perioperative Right Ventricular Dysfunction Undergoing Transcatheter Aortic Valve Replacement Jesus E. Pino1, Fergie J. Ramos Tuarez1, Julio Grajeda Chavez1, Samineh Sehatbakhsh1, Pedro Torres2, Gustavo Avila Amat1, Robert Chait1, Baher S. Al Abbasi1, Edwin Grajeda1, Robert Chait1; 1University of Miami/ JFK Medical Center, West Palm Beach, FL; 2University of Miami/ JFK Medical Center, Atlantis, FL Background: Right ventricular dysfunction (RVD) has been associated with worst long-term outcome in patients undergoing surgical aortic valve replacement (SAVR). However, there are conflicting data about the long-term consequences of RVD in patients undergoing TAVR. Purpose: To evaluate the long-term outcomes of perioperative RVD in patients with severe aortic undergoing TAVR. Methods: This is a retrospective cohort study of patients that underwent TAVR in a tertiary cardiovascular center. Right ventricular function was evaluated in the perioperative period (within seven days post-TAVR period) allowing for improvement on left ventricular and right ventricular function after releasing the LVOT obstruction. RV function was dichotomized into two groups for this retrospective analysis. Evaluated outcomes included 30-day mortality, 1-year mortality, hospital stay (LOS), acute kidney injury (AKI), and 30-day readmission rate. Results: A total of 409 patients were included in the analysis. Out of 409 patients, 180 (44%) were female with a mean age of 84.6 § 6.7 years; their mean society of thoracic surgeon score (STS) was 6.4 §3.8. Transfemoral approach was performed in 313 (77%) patients. A total of 24/409 patients had right ventricular failure within seven days post-TAVR. Please, see table 1 for baseline characteristics. In patients with RVD, one-month mortality occurred in 3/24 (12.5%) patients vs. 19/385 (4.94) in patients with normal right ventricular function p-value 0.1307. One-year mortality was higher in patients with RVD 9/24 (37%) vs. 60 (15%) for patients with normal RV function p-value 0.0103. Post TAVR acute kidney injury was present in 8/24 (33%) patients with RVD vs. 108/385 (28%) for patients with
Background: The prevalence and impact of lower extremity peripheral arterial disease (PAD) in patients with heart failure (HF) remains unclear. The purpose of this study was to prospectively examine the prevalence and clinical characteristics associated with PAD defined by the ankle brachial index (ABI) in an outpatient cohort of HF patients. Methods: Clinical history, laboratory, and echocardiographic data were collected prospectively. Subjects underwent ABI measurement with calculation of both the ABI-HI (highest pedal pressure/highest brachial pressure) and ABI-LO (lowest pedal pressure/ highest brachial pressure). Subjects also underwent a 6-MWD, sit to stand test, and quality of life questionnaires (QoL). Results: A total of 103 patients were included. Abnormal ABI-LO and ABI-HI were identified in 28 (27%) and 16 (16%) of the patients, respectively. The average 6MWD was 387mts. By ABI-LO 24(23%) subjects had an ABI0.9 and 4(4%) had an ABI>1.4. Using ABI-HI 9(9%) had an ABI0.9 and 7(7%) had an ABI>1.4 An ABI-HI0.9 was more common in those with claudication (16% v. 3%, p=0.02). After adjusting for age and gender, the presence of neuropathy(OR:3.55, 95%CI:1.23-10.22), cardiomyopathy (ischemic vs non-ischemic; OR:3.10,95%CI:1.039.28), and worse NYHA class (OR:2.41, 95%CI:1.21-4.80) were associated with an abnormal ABI-LO. Conversely, in a model adjusted for age and gender, eGFR(OR:0.96, 95%CI:0.94-0.99) and peripheral neuropathy (OR:6.70, 95%CI:1.76-25.48) were significantly associated with an abnormal ABI-HI. ABI-LO but not ABI-HI was correlated with 6MWD<387m; after adjusting for age, both a history of prior CABG and ABI-LO0.9 remained independently associated with 6MWD. There was no association of ABIs with QoL. Conclusions: PAD may be as high as 27% in the ambulatory HF population and vary by calculation method. Ischemia, worsening HF, and eGFR were commonly associated with abnormal ABIs. ABIs had a small but significant correlation with 6-MWD but not of quality of life scores.