The aim of this study was to evaluate the presence of cardiac ultrasound changes correlated with the prevalence of arterial hypertension (HT) in patients with peripheral artery disease (PAD) with critical leg ischemia (CLI) comparative with patients without CLI. LV hypertrophic remodeling related to HT prevalence is underdiagnosed in PAD patients, in whom the arterial imaging evaluation it is priority made.
Our study enrolled 197 patients with PAD patients: 142 pts. (63,1 ± 9,4 yrs., 88,% male, 70% smokers) with CLI and 55 pts. (60,4 ± 10,6 yrs., 85% male, 65% smokers) without CLI. After signing an informed consent, all patients were clinically evaluated, laboratory tested (glucose, cholesterol, triglyceride serum levels) and cardiac ultrasound was performed. The cardiac ultrasound parameters measurements were related to end-diastolic septum wall thickness (SWTd) and left ventricular (LV) posterior wall thickness (LVPWTd), LV relative wall thickness (RWT) and LV diastolic (LVD) function quantification. The study methodology was approved by the Ethical Committee. Statistical data processing was performed with SPSS.
The prevalence of HT (66,3%) was higher than diabetes (50,2%, p < 0,01), hypercholesterolaemia (52,1%, p < 0,01), hypertriglyceridaemia (47,6%, p < 0,01) and it was higher in PAD patients with CLI (71,2%) comparative with PAD patients without CLI (53,4%, p < 0,001). We found symmetric or asymmetric concentric LV hypertrophy (RWT > 0,42) in 51,5% of PAD patients (53,6% in PAD patients with CLI versus 47,7% in PAD patients without CLI, ns). The prevalence of increase SWTd thickness (53,2%) was higher (53,8% in PAD patients with CLI versus 52,7% in PAD patients without CLI, ns; 10,6 ± 2,3 mm versus. 10,5 ± 2,4%) than increase LVPWTd thickness (41,3%, p < 0,01), (38% in PAD patients with CLI versus 51,8% in PAD patients without CLI, p < 0,001; 10,1 ± 1,69 mm versus 10,2 ± 2,2 mm). LVD dysfunction was present in 36,2% of PAD patients (37,4% versus 35,1%, ns). The prevalence of diagnosed hypertensive cardiac disease in PAD patients increased from 3,1% on admission to 32,4% (p < 0,001).
High prevalence of HT in PAD patients (especially with CLI), correlated with the LV hypertrophy and diastolic dysfunction presence, reveal the need for sustained antihypertensive treatment in this usually undertreated group of patients.
University of Medicine and Pharmacy Iuliu Hatieganu, Department of Cardiology County Clinical Emergency Hospital, Cluj-Napoca, Romania