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Cardiac Function, Inflammatory Mediators and Mortality in Critical Limb Ischemia

University of Lund, Department of Vascular Diseases, Malmö University Hospital, S-205 02 Malmö, Sweden; jamal.barani{at}skane.se

Ingrid Mattiasson, MD, PhD

Bengt Lindblad, MD, PhD

Anders Gottsäter, MD, PhD

University of Lund, Department of Vascular Diseases, Malmö University Hospital, Malmö, Sweden

Patients with critical limb ischemia (CLI) have a high frequency of concomitant coronary heart disease and congestive heart failure. The aim of the study was to evaluate cardiac function in relation to inflammatory markers and 1-year mortality rate among patients with CLI. The authors investigated 232 consecutive patients with CLI by means of electrocardiogram (ECG), and measurements of endothelin (ET)-1, tumor necrosis factor alpha (TNF)a, interleukin (IL)-6, neopterin, CD40 ligand, and 8-epi-prostaglandin (PG)F₂a in plasma. Echocardiography (echo) was performed in 88 (38%) patients. One-year mortality rate was assessed after prospective follow-up. One hundred and eighty-six (80%) patients had sinus rhythm (SR), 36 (16%) had atrial fibrillation or flutter (AF), and 10 (4%) pacemaker rhythm. Ischemic ECG changes occurred in 143 (62%) patients. Patients with AF showed higher IL-6 (p=0.0296) and neopterin (p=0.0494) concentrations. Patients with ischemic ECG changes showed higher ET-1 (p=0.0303), 8-epi-PGF₂a (p=0.0027), neopterin (p=0.0004) concentrations and 1-year mortality rate (p=0.0105). The difference in ET-1 remained in logistic regression (p=0.0152). Internal diameter of the left ventricle on echo correlated with IL-6 (r =0.345, p=0.0017), TNFa (r =0.240, p=0.0273), and neopterin (r =0.327, p=0.0028). Internal diameter of the left atrium correlated with TNFa (r =0.384, p=0.0092) and neopterin (r =0.526, p=0.0004), and ejection fraction (EF) correlated inversely with IL-6 (r =-0.380, p=0.0015) and neopterin (r =-0.346, p=0.0038). Patients with EF <40% showed higher (p=0.0462) 1-year mortality rate than patients with EF >40%. In conclusion, in critical limb ischemia, cardiac rhythm disturbances and ischemic ECG changes were related to inflammatory mediators and predicted 1-year mortality rate. The inflammatory mediators correlated with echocardiographic signs of congestive heart failure.

Angiology, Vol. 57, No. 4, 437-444 (2006)
DOI: 10.1177/0003319706290743


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