Gherasie Flavius-Alexandru, Popescu Mihaela-Roxana, Achim Alexandru, Bartos Daniela
Department of Cardiology, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania.
Emergency Clinical Hospital Dr. Bagdasar-Arseni, 050474 Bucharest, Romania.
J Pers Med. 2024 Feb 26;14(3):251. doi: 10.3390/jpm14030251.
Peripheral artery disease is a condition that causes narrowing of the arteries, impairing circulation to the extremities. Globally, it affects millions of people and is more prevalent in older adults and those with diabetes, high blood pressure, or high cholesterol. There is an overlap specific to polyvascular patients, and almost 50% of patients with PAD have coronary artery disease. Compelling evidence reveals a noteworthy association between PAD and major adverse cardiovascular events (MACEs) in individuals experiencing acute coronary syndrome (ACS) but limited knowledge exists regarding the influence of PAD on left ventricular systolic function during ACS.
In a retrospective case-control study, we examined 100 participants who presented with ACS (mean age = 61.03 years, 80 [80%] males). The patients were divided into two groups: the ACS-PAD group (32 subjects, 74% of them with STEMI, 10% with NSTEMI, and 16% with NSTEACS) and the ACS-nonPAD group (68 participants).
This study highlighted that PAD negatively impacts patients with non-ST-segment elevation myocardial infarction (NSTEMI). These patients were likely to experience a decline of approximately 19.3% in their left ventricular ejection fraction (LVEF) compared to the ACS-nonPAD group ( = 0.003) and presented a worse clinical status (the PAD group correlated with Killip class IV, = 0.049).
Our analysis indicates that patients diagnosed with NSTEACS and PAD tend to have a higher LVEF of over 55% and a lower HEART score. Patients with PAD tend to have a functionally higher EF but clinically present with more unstable scenarios (pulmonary edema and cardiogenic shock). This is mainly driven by a higher prevalence of HFpEF in the PAD group. Looking closer at the PAD group, they have a higher incidence of comorbidities such as diabetes, hypertension, high cholesterol, CAD, and stroke, as well as being more active smokers.
外周动脉疾病是一种导致动脉狭窄、影响肢体血液循环的病症。在全球范围内，它影响着数百万人，在老年人以及患有糖尿病、高血压或高胆固醇的人群中更为普遍。多血管疾病患者存在特定的重叠情况，几乎50%的外周动脉疾病患者患有冠状动脉疾病。有力证据表明，外周动脉疾病与急性冠状动脉综合征（ACS）患者的主要不良心血管事件（MACE）之间存在显著关联，但关于外周动脉疾病对急性冠状动脉综合征期间左心室收缩功能的影响，目前了解有限。
在一项回顾性病例对照研究中，我们检查了100名患有急性冠状动脉综合征的参与者（平均年龄 = 61.03岁，80名[80%]为男性）。患者被分为两组：急性冠状动脉综合征 - 外周动脉疾病组（32名受试者，其中74%为ST段抬高型心肌梗死，10%为非ST段抬高型心肌梗死，16%为非ST段抬高型急性冠状动脉综合征）和急性冠状动脉综合征 - 非外周动脉疾病组（68名参与者）。
本研究强调外周动脉疾病对非ST段抬高型心肌梗死（NSTEMI）患者有负面影响。与急性冠状动脉综合征 - 非外周动脉疾病组相比，这些患者的左心室射血分数（LVEF）可能会下降约19.3%（P = 0.003），并且临床状况更差（外周动脉疾病组与Killip分级IV级相关，P = 0.049）。
我们的分析表明，被诊断为非ST段抬高型急性冠状动脉综合征和外周动脉疾病的患者往往左心室射血分数高于55%且HEART评分较低。外周动脉疾病患者的左心室射血分数在功能上较高，但临床上表现出更不稳定的情况（肺水肿和心源性休克）。这主要是由外周动脉疾病组中射血分数保留的心力衰竭（HFpEF）患病率较高所驱动。仔细观察外周动脉疾病组，他们合并症（如糖尿病、高血压、高胆固醇、冠心病和中风）的发生率更高，而且吸烟更频繁。
