Pulse Pressure and Prognosis in Patients with Heart Failure with Reduced Ejection Fraction.

Authors

Neeraj Shah MD, Lehigh Valley Health NetworkFollow
Min Qian PhDFollow
Marco R. Di Tullio MDFollow
Susan Graham MDFollow
Douglas L. Mann MDFollow
Ralph L. Sacco MD, MSFollow
Gregory Y H Lip MDFollow
Arthur J. Labovitz MDFollow
Piotr Ponikowski MD, PhDFollow
Dirk J. Lok MDFollow
Stefan D. Anker MD, PhDFollow
John R. Teerlink MDFollow
John L P Thompson PhDFollow
Shunichi Homma MDFollow
Ronald S. Freudenberger MD, Lehigh Valley Health NetworkFollow
WARCEF Investigators

Publication/Presentation Date

2-23-2019

Abstract

BACKGROUND: A high pulse pressure (PP) is associated with adverse cardiovascular (CV) outcomes; however this relationship may be reversed in patients with heart failure with reduced ejection fraction (HFREF).

METHODS: Patients from the WARCEF trial with left ventricular ejection fraction < 35% were included. PP was divided into tertiles:54 mm Hg. Age and ejection fraction adjusted Kaplan Meier curves were generated to evaluate the relationship between PP and outcomes [mortality, CV mortality, stroke and HF hospitalizations (HFH)]. Cox proportional hazards models were created incorporating PP as a continuous variable. The interaction of PP with New York Heart Association (NYHA) functional class was examined. Linear and restricted cubic splines were used to study nonlinear association between PP and outcomes.

RESULTS: We included 2,299 patients with a mean(+/- SD) follow-up of 3.5 +/- 1.8 years. The lowest tertile of PP (Hg) was associated with significantly higher CV mortality and HFH. Cox proportional hazards models showed a reduction in CV death and HFH with higher PP, with adjusted hazard ratios (HR) of 0.91 (p=0.02) and 0.93 (p=0.04) per 10 mm Hg increase in PP. This relationship was more pronounced in subjects with NYHA functional class III-IV. Spline analysis showed that the association between PP and CV mortality and HFH was only seen at PP values lower than 40-50 mm Hg.

CONCLUSIONS: In patients with advanced HFREF, a low PP (Hg) portends a worse prognosis, whereas a high PP (>50 mm Hg) predicts a relatively favorable prognosis. This article is protected by copyright. All rights reserved.

Volume

49

Issue

6

First Page

13092

Last Page

13092

ISSN

1365-2362

Published In/Presented At

Shah, N. Qian, M. Di Tullio, M. R., Graham, S. Mann, D. L., Sacco, R. L., Lip, G. YH., Labovitz, A. J., Ponikowski, P. P. Lok, D. J., Anker, S. D., Teerlink, J. R., Thompson, J. LP., Homma, S. Freudenberger, R. S., WARCEF Investigators. (2019). Pulse Pressure and Prognosis in Patients with Heart Failure with Reduced Ejection Fraction. European journal of clinical investigation. 49(6), doi: 10.1111/eci.13092.

Disciplines

Cardiology

PubMedID

30801690

Department(s)

Department of Medicine, Cardiology Division, Department of Medicine Faculty

Document Type

Article