Pulse Pressure in Heart Failure Patients With Reduced EF
Pulse Pressure in Heart Failure Patients With Reduced EF
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.
Elevated pulse pressure is an established marker of adverse outcome in healthy individuals as well as patients with certain types of cardiovascular disease, especially those with hypertension. More recently, lower pulse pressure has emerged as an independent predictor of mortality in patients with heart failure (HF). This has been demonstrated in patients across the spectrum of symptom severity, and in patients with acute as well as chronic HF. However, studies to date have included only patients with heart failure and reduced left ventricular ejection fraction (HF-REF). Patients with heart failure and preserved left ventricular ejection fraction (HF-PEF) more often have a history of hypertension than patients with HF-REF, and therefore, may be more likely to have an elevated pulse pressure. However, the range of pulse pressures in patients with HF-PEF, compared with HF-REF, is unknown, as is the prognostic importance of pulse pressure in HF-PEF.
We used data from 22 HF studies included in the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) to explore these questions.
Abstract and Introduction
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.
Introduction
Elevated pulse pressure is an established marker of adverse outcome in healthy individuals as well as patients with certain types of cardiovascular disease, especially those with hypertension. More recently, lower pulse pressure has emerged as an independent predictor of mortality in patients with heart failure (HF). This has been demonstrated in patients across the spectrum of symptom severity, and in patients with acute as well as chronic HF. However, studies to date have included only patients with heart failure and reduced left ventricular ejection fraction (HF-REF). Patients with heart failure and preserved left ventricular ejection fraction (HF-PEF) more often have a history of hypertension than patients with HF-REF, and therefore, may be more likely to have an elevated pulse pressure. However, the range of pulse pressures in patients with HF-PEF, compared with HF-REF, is unknown, as is the prognostic importance of pulse pressure in HF-PEF.
We used data from 22 HF studies included in the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) to explore these questions.
