Background: Recent research indicates that there is a high prevalence of HFpEF in patients with PAD. We hypothesized that endovascular treatment (EVT) of flow-limiting peripheral stenosis improves left ventricular diastolic function (LVDF).

Methods: Thirty patients with symptomatic PAD and HFpEF according to HFA-PEFF score who were scheduled for EVT or angiography were investigated at baseline, the day after EVT (n=25) or angiography (control, n=5), and at 4 months follow-up. Peripheral hemodynamics were determined by the total peripheral resistance (TPR), common femoral artery flow and ABI. Aortic function was measured by the arterial compliance, AIx, and PWV. Aortic pulsatile load was estimated as the characteristic impedance of the proximal aorta (Zc) and the magnitude of wave reflection (RC). Left ventricular mass index (LVMI), LV mean wall thickness, and systolic and diastolic function were assessed using echocardiography. Patient-centered outcomes were treadmill walking distance (TMWD) and NYHA class.

Results: After EVT, peripheral hemodynamics changed significantly with a decrease in TPR and increases in CFA flow and ABI. Aortic function improved after EVT, with significantly reduced AIx and PWV and increased compliance immediately and at follow-up, resulting in a reduction in aortic pulsatile load (Zc, RC). Concurrently, LVDF improved after EVT compared to control, acutely and at follow-up, with increased septal and lateral e´ velocities and a decreased E/e´ and LAVI. The LVMI and LV mean wall thickness decreased at follow-up. The NYHA class and TMWD improved post-EVT at follow-up. AIx, PWV and arterial compliance were identified as independent contributors to E/e´.

Conclusion: EVT of flow-limiting iliofemoral stenosis reduces aortic pulsatile load and concurrently lowers TPR. This beneficial effect is associated with acute and sustained improvement of LVDF.