18 F‐FDG‐PET/CT is promising tool to visualize not only transvenous lead infection but also epicardial lead infection.

Introduction: Lower extremity artery disease (LEAD) is an arterial occlusive disease characterized by an insufficient blood supply to the lower limb arteries. The H2FPEF score, calculated using simple clinical characteristics and echocardiographic findings, has been developed to identify patients at high risk for heart failure (HF) with preserved ejection fraction. Purpose: This study aimed to assess the impact of modified H2FPEF scores on chronic limb-threatening ischemia (CLTI) in patients with LEAD. Methods: Since the definition of obesity differs by race, we calculated the modified H2FPEF score using a body mass index > 25 kg/m2 in 293 patients with LEAD who underwent their first endovascular therapy. Patients were retrospectively followed for a median follow-up period of 718 days. The primary and secondary endpoints were newly developed CLTI and composite events, including mortality due to worsening HF or rehospitalization in addition to CLTI, respectively. Results: The modified H2FPEF score significantly increased with advancing Fontaine classes. Kaplan-Meier analysis demonstrated that the highly modified H2FPEF score group (≥ 3) had a higher incidence of newly developed CLTI and composite events than the low H2FPEF score group (<3). Multivariate Cox proportional hazard analysis revealed that the modified H2FPEF score was an independent predictor of newly developed CLTI and composite events after adjustment for confounding risk factors. The net reclassification index and integrated discrimination improvement were significantly improved by adding the modified H2FPEF score to the basic predictors. Conclusions: The modified H2FPEF score was associated with LEAD severity and future CLTI development, suggesting that it could be a feasible marker for patients with LEAD.

Introduction: Lower extremity artery disease (LEAD) is an arterial occlusive disease associated with high morbidity and mortality. Estimated plasma volume status (ePVS), a marker of plasma volume expansion and contraction, is gaining attention in the field of cardiovascular disease. However, it remains undetermined the impact of ePVS on clinical outcome in patients with LEAD. Methods: We calculated two ePVS using Kaplan-Hakim and Duarte formula in 288 LEAD patients who underwent first endovascular therapy and retrospectively followed during a median follow-up period of 617 days. The primary and secondary endpoints were composite events including all-cause death and major adverse limb events (Death/MALE) and major adverse cardiovascular events (MACE), respectively. Results: ePVS significantly increased with advancing Fontaine class. All patients were divided into two groups based on the median ePVS value. Kaplan-Meier analysis demonstrated high ePVS group had higher incidence of composite events and MACE compared to low ePVS group. A multivariate Cox proportional hazard analysis revealed that ePVS was an independent predictor of Death/MALE and MACE after adjustment for confounding risk factors. Prognostic ability for Death/MALE was significantly improved by addition of ePVS to the basic predictors. These results are consistent with each formula. Conclusions: ePVS was associated with severity of LEAD and clinical outcome, suggesting ePVS could be an additional risk factor for Death/MALE and MACE in LEAD patients who underwent endovascular therapy.

Background: Lower extremity artery disease (LEAD) is an arterial occlusive disease characterized by an insufficient blood supply to the lower limb arteries. The H2FPEF score, comprising Heavy, Hypertensive, atrial Fibrillation, Pulmonary hypertension, Elder, and Filling pressure, has been developed to identify patients at high risk of heart failure (HF) with preserved ejection fraction. This study assessed the impact of modified H2FPEF scores on chronic limb-threatening ischemia (CLTI) in patients with LEAD. Methods and Results:This study was a prospective observational study. Because the definition of obesity differs by race, we calculated the modified H2FPEF score using a body mass index >25 kg/m 2 to define obesity in 293 patients with LEAD who underwent first endovascular therapy. The primary endpoints were newly developed and recurrent CLTI. The secondary endpoint was a composite of events, including mortality and rehospitalization due to worsening HF and/or CLTI. The modified H2FPEF score increased significantly with advancing Fontaine classes. Multivariate Cox proportional hazard analysis revealed that the modified H2FPEF score was an independent predictor of newly developed and recurrent CLTI and composite events. The net reclassification index and integrated discrimination improvement were significantly improved by adding the modified H2FPEF score to the basic predictors. Conclusions:The modified H2FPEF score was associated with LEAD severity and future CLTI development, suggesting that it could be a feasible marker for patients with LEAD.

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