High prevalence of important cardiac findings in patients with peripheral arterial disease referred for echocardiography

Background: Patients with peripheral arterial disease (PAD) diagnosed by ankle-brachial index evaluation are known to have high cardiovascular mortality. Although this has primarily been attributed to coexistent coronary artery disease, the prevalence of abnormal echocardiographic findings for patients with PAD has not been studied. Our goal was to study the association between PAD and clinically important echocardiographic findings in symptomatic patients with PAD referred for echocardiography. Methods. Eligible patients were identified from a database of 615 consecutive patients referred for clinically indicated ankle-brachial index evaluation in our vascular laboratory. Patients were included (n=309) if they also had a complete transthoracic echocardiogram in the digital echocardiogram database at our institution. Final transthoracic echocardiographic reports were retrospectively reviewed for study indication and clinically important echocardiographic findings. Patients with PAD (ankle-brachial index <0.9) (n=190) were compared with patients without PAD (n=119). Results: Patients with PAD were found to have a high prevalence of clinically important echocardiographic findings, and significantly more clinically important echocardiographic findings (61.6% vs 35.3%, P<.001), including more left ventricular (LV) dysfunction and aortic stenosis, than patients without PAD. On multivariate logistic regression analysis, the presence of PAD was found to be an independent predictor of LV ejection fraction <50% (odds ratio 2.86, 95% confidence interval 1.54-5-32, P=.001), IV ejection fraction <35% (odds ratio 2.48, 95% confidence interval 1.22-5.07, P=.02), and any clinically important echocardiographic finding (odds ratio 2.65, 95% confidence interval 1.61-4-36, P<.001). Conclusion: In symptomatic patients with PAD referred for echocardiography, there is a high prevalence of clinically important echocardiographic findings, including IV dysfunction, and PAD appears to be an independent predictor of an abnormal echocardiogram. These findings suggest that a prospective echocardiographic screening study in symptomatic patients with PAD is warranted.