The Association of Cardiac Valve Sclerosis with Clinical Outcomes in Patients Undergoing Endovascular Revascularization for Peripheral Arterial Disease

Abstract

Background Peripheral arterial disease (PAD) is known to be associated with poor outcomes and cardiac valve sclerosis (CVS) is reported to be associated with future cardiovascular events. We evaluated the association of CVS with the clinical outcomes in patients (pts) with PAD who underwent percutaneous transluminal angioplasty (PTA).

Method The outcomes of 298 consecutive pts with symptomatic PAD who underwent PTA were enrolled for analysis. Study populations were divided into two groups; PAD with CVS (n=41) and PAD without CVS (n=257). CVS (Aortic or mitral valve sclerosis) is defined as calcification and thickening of leaflets in aortic or mitral valve in the absence of obstruction of ventricular outflow. The incidence of restenosis, amputation rates and clinical outcomes were assessed at a follow-up of 2 years.

Results Pts with CVS had higher incidence of wounds as the initial diagnosis for PAD (80.5% vs. 56.0%, p=0.003), diabetes mellitus (92.7% vs.70.8%, p=0.002), hypertension (87.8% vs. 67.3%, p=0.009), chronic kidney disease (43.9% vs. 23.0 %, p=0.007), need for dialysis (34.1% vs. 16.0%, p=0.009), and previous history of percutaneous coronary intervention (26.8% vs. 13.6%, P=0.037). At 8 months follow-up, patients with CVS had higher rate of total occlusion of the limb (83.3% vs. 33.6%, p=0.023). At 2-year follow up, the incidence of repeat PTA and major adverse cardiovascular events (MACE) was similar between the two groups, but the pts with CVS had higher amputation rate (39.3% vs. 15.6%, p=0.005).

Conclusion In this study, patients with CVS had more frequently presented with critical limb ischemia, higher rates of total occlusion and amputation rate at 2 years following successful PTA compared with those of PAD without CVS. More intensive therapies will be needed for this particular subset of risky patients.