Relation of the Ankle Brachial Index to Left Ventricular Ejection Fraction in Patients Without Coronary Artery Disease

Background: The low ankle brachial index (ABI) values are indicative of peripheral arterial disease, but have recently been found to be associated with reduced left ventricular ejection fraction (LVEF). This may relate to coexisting coronary artery disease (CAD). Aim: This study prospectively assessed a potential ABI-LVEF association in patients without CAD. Methods and Results: We studied 55 patients (age 57 +/- 13 years, 49% male) with normal coronary arteries with LVEF determination. ABI, pulse wave velocity (PWV), and augmentation index (AI) were performed after coronary angiography. ABI correlated with LVEF (r= 0.40, p= 0.002), but not with PWV or AI. On linear regression analysis, ABI was independently associated with LVEF (B= 0.42, p= 0.004). The median LVEF was lower in subjects with low ABI values compared to those with normal ABI values (33 vs. 61%; p= 0.001). Conclusion: ABI may be influenced by LVEF independently of CAD, arterial stiffness or pressure wave reflection.