Calf rEF: Impact of Calf Muscle Pump Dysfunction With Reduced Ejection Fraction on All-Cause Mortality

Robert D McBane; David Liedl; Waldemar Wysokinski; Paul W Wennberg; Ana I Casanegra; Atefeh Ghorbanzadeh; Adelaide Arruda-Olson; Christopher G Scott; Alex T Lee; Azza Ahmed; Thom W Rooke; Damon E Houghton

doi:10.1016/j.mayocp.2023.08.013

Calf rEF: Impact of Calf Muscle Pump Dysfunction With Reduced Ejection Fraction on All-Cause Mortality

Mayo Clin Proc. 2024 Apr 24:S0025-6196(23)00406-8. doi: 10.1016/j.mayocp.2023.08.013. Online ahead of print.

Affiliations

¹ Gonda Vascular Center, Mayo Clinic, Rochester, MN; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN. Electronic address: mcbane.robert@mayo.edu.
² Gonda Vascular Center, Mayo Clinic, Rochester, MN; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
³ Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
⁴ Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN.

PMID: 38661596
DOI: 10.1016/j.mayocp.2023.08.013

Abstract

Objective: To evaluate mortality outcomes by varying degrees of reduced calf muscle pump (CMP) ejection fraction (EF).

Patients and methods: Consecutive adult patients who underwent venous air plethysmography testing at the Mayo Clinic Gonda Vascular Laboratory (January 1, 2012, through December 31, 2022) were divided into groups based on CMP EF for the assessment of all-cause mortality. Other venous physiology included measures of valvular incompetence and clinical venous disease (CEAP [clinical presentation, etiology, anatomy, and pathophysiology] score). Mortality rates were calculated using the Kaplan-Meier method.

Results: During the study, 5913 patients met the inclusion criteria. During 2.84-year median follow-up, there were 431 deaths. Mortality rates increased with decreasing CMP EF. Compared with EF of 50% or higher, the hazard ratios (95% CIs) for mortality were as follows: EF of 40% to 49%, 1.4 (1.0 to 2.0); EF of 30% to 39%, 1.6 (1.2 to 2.4); EF of 20% to 29%, 1.7 (1.2 to 2.4); EF of 10% to 19%, 2.4 (1.7 to 3.3) (log-rank P≤.001). Although measures of venous valvular incompetence did not independently predict outcomes, venous disease severity assessed by CEAP score was predictive. After adjusting for several clinical covariates, both CMP EF and clinical venous disease severity assessed by CEAP score remained independent predictors of mortality.

Conclusion: Mortality rates are higher in patients with reduced CMP EF and seem to increase with each 10% decrement in CMP EF. The mortality mechanism does not seem to be impacted by venous valvular incompetence and may represent variables intrinsic to muscular physiology.