Purpose: To evaluate the impact of asymptomatic peripheral artery disease (PAD) on exercise recovery in patients with heart failure (HF).
Methods: The study enrolled 204 HF patients in stable conditions, mean age 72 ± 12 years, M/F 138/66, consecutively admitted to our cardiac rehabilitation unit. Asymptomatic PAD was assessed by ankle/brachial index (ABI). Subjects with history of symptomatic PAD were excluded from the study. Exercise tolerance was evaluated by six minute walking test (6mwt). At admission patients were divided into three group according to their ABI index (ABI >0.9; ABI 0.6-0.9; ABI <0.6). All patients underwent an 8-weeks program of aerobic exercise training at 60-70% of heart rate reserve.
Results: Overall 52% of patients had ABI<0.9. At baseline patients with ABI <0.6 were older, had a higher rate of hypertension, diabetes, atrial fibrillation and a lower ejection fraction (EF) the other two groups. ABI resulted significantly related to EF, and it was inversely related to creatinine levels. After exercise training patients with ABI <0.6 and ABI 0.6-0.9 had a significantly lower recovery of exercise capacity (25.7% and 31.6% respectively) than patients with ABI >0.9 (41.9%). In a multivariate logistic regression model, including several covariates, asymptomatic PAD predicted a reduced performance at 6MWT in the overall population (adjusted OR 1.82; 95% CI 1.66-2.11; p=0.03).
Conclusions: Asymptomatic PAD is a marker of advanced HF and reduced physical performance. HF patients with asymptomatic PAD have lower functional recovery than subjects without asymptomatic PAD after exercise training. Asymptomatic PAD seems to be related to lack of benefit of exercise training in HF patients and a marker of frailty of these patients.