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The Prevalence, Clinical Characteristics, and Functional Significance of Ankle Brachial Index Defined Peripheral Arterial Disease in Patients with Heart Failure
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.
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.