Colette E Jackson1, Davide Castagno2, Aldo P Maggioni3, Lars Køber4, Iain B Squire5, Karl Swedberg6, Bert Andersson7, A Mark Richards8, Antoni Bayes-Genis9, Christophe Tribouilloy10, Joanna Dobson11, Cono A Ariti11, Katrina K Poppe12, Nikki Earle12, Gillian Whalley13, Stuart J Pocock11, Robert N Doughty12, John J V McMurray14. 1. BHF Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK colettejackson@doctors.org.uk. 2. Division of Cardiology, Città della Salute e della Scienza Hospital, Department of Medical Sciences, University of Turin, Torino, Italy. 3. Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy. 4. Department of Cardiology, Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark. 5. University of Leicester and NIHR Biomedical Research Unit, Glenfield Hospital, Leicester, UK. 6. National Heart and Lung Institute, Imperial College, London, UK Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden. 7. Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden. 8. Department of Medicine, University of Otago, Christchurch, New Zealand National University Heart Centre, Singapore. 9. Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. 10. Department of Cardiology, University Hospital Amiens, Amiens, France INSERM U-1088, JulesVerne University of Picardie, Amiens, France. 11. Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK. 12. Department of Medicine and National Institute for Health Innovation, University of Auckland, Auckland, New Zealand. 13. Unitec Institute of Technology, Auckland, New Zealand. 14. BHF Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK.
Abstract
AIMS: Low pulse pressure is a marker of adverse outcome in patients with heart failure (HF) and reduced ejection fraction (HF-REF) but the prognostic value of pulse pressure in patients with HF and preserved ejection fraction (HF-PEF) is unknown. We examined the prognostic value of pulse pressure in patients with HF-PEF [ejection fraction (EF) ≥ 50%] and HF-REF. METHODS AND RESULTS: Data from 22 HF studies were examined. Preserved left ventricular ejection fraction (LVEF) was defined as LVEF ≥ 50%. All-cause mortality at 3 years was evaluated in 27 046 patients: 22 038 with HF-REF (4980 deaths) and 5008 with HF-PEF (828 deaths). Pulse pressure was analysed in quintiles in a multivariable model adjusted for the previously reported Meta-Analysis Global Group in Chronic Heart Failure prognostic variables. Heart failure and reduced ejection fraction patients in the lowest pulse pressure quintile had the highest crude and adjusted mortality risk (adjusted hazard ratio 1.68, 95% confidence interval 1.53-1.84) compared with all other pulse pressure groups. For patients with HF-PEF, higher pulse pressure was associated with the highest crude mortality, a gradient that was eliminated after adjustment for other prognostic variables. CONCLUSION: Lower pulse pressure (especially <53 mmHg) was an independent predictor of mortality in patients with HF-REF, particularly in those with an LVEF < 30% and systolic blood pressure <140 mmHg. Overall, this relationship between pulse pressure and outcome was not consistently observed among patients with HF-PEF. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Low pulse pressure is a marker of adverse outcome in patients with heart failure (HF) and reduced ejection fraction (HF-REF) but the prognostic value of pulse pressure in patients with HF and preserved ejection fraction (HF-PEF) is unknown. We examined the prognostic value of pulse pressure in patients with HF-PEF [ejection fraction (EF) ≥ 50%] and HF-REF. METHODS AND RESULTS: Data from 22 HF studies were examined. Preserved left ventricular ejection fraction (LVEF) was defined as LVEF ≥ 50%. All-cause mortality at 3 years was evaluated in 27 046 patients: 22 038 with HF-REF (4980 deaths) and 5008 with HF-PEF (828 deaths). Pulse pressure was analysed in quintiles in a multivariable model adjusted for the previously reported Meta-Analysis Global Group in Chronic Heart Failure prognostic variables. Heart failure and reduced ejection fraction patients in the lowest pulse pressure quintile had the highest crude and adjusted mortality risk (adjusted hazard ratio 1.68, 95% confidence interval 1.53-1.84) compared with all other pulse pressure groups. For patients with HF-PEF, higher pulse pressure was associated with the highest crude mortality, a gradient that was eliminated after adjustment for other prognostic variables. CONCLUSION: Lower pulse pressure (especially <53 mmHg) was an independent predictor of mortality in patients with HF-REF, particularly in those with an LVEF < 30% and systolic blood pressure <140 mmHg. Overall, this relationship between pulse pressure and outcome was not consistently observed among patients with HF-PEF. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Renata R T Castro; Luka Lechnewski; Alan Homero; Denilson Campos de Albuquerque; Luis Eduardo Rohde; Dirceu Almeida; João David; Salvador Rassi; Fernando Bacal; Edimar Bocchi; Lidia Moura Journal: Arq Bras Cardiol Date: 2021-01 Impact factor: 2.000
Authors: Boon C Ng; Matthias Kleinheyer; Peter A Smith; Daniel Timms; William E Cohn; Einly Lim Journal: PLoS One Date: 2018-04-20 Impact factor: 3.240