Cardiovascular Prognosis in Limb Ischemia Patients with Heart Failure and Systolic Dysfunction Following Major Amputation

Chronic limb-threatening ischemia (CLTI), the severest stage of peripheral artery disease, frequently necessitates amputation. In CLTI patients, heart failure with reduced ejection fraction (HFrEF) markedly raises mortality risk, with increased peripheral vascular resistance contributing to this exacerbation. This investigation aimed to assess the impact of major amputation (MA) on the cardiovascular (CV) prognosis in CLTI patients with HFrEF by lowering peripheral vascular resistance. Conducting a retrospective, observational analysis at a single center, a total of 60 patients with CLTI and HFrEF (EF<50%) who underwent endovascular therapy (EVT) at our institution were assessed. We compared CV outcomes in CLTI patients with HFrEF who received MA (n=17) to those who did not (n=43) after undergoing EVT. During the follow-up period, which median 641 (IQR: 245-1,734) days post-EVT, a composite primary endpoint of CV death or hospitalization for heart failure was observed. During the study period, 19 patients (32%) were admitted for HF or died as a consequence of CV events. Kaplan-Meier analysis revealed a significantly reduced incidence of the primary endpoint in the MA cohort (log-rank test: p=0.035). Adjustments for age and sex showed MA was significantly linked to improved CV prognosis (HR: 0.19; 95% CI: 0.04-0.87). A nonsignificant trend towards decreased overall mortality was noted in the MA group, with infections being the predominant cause of death across both groups. In conclusion, in CLTI patients with HFrEF, MA might be linked to reduced CV events, proposing it as a potential definitive strategy for improving CV outcomes in this high-risk population.