Brachial pulse pressure in acute heart failure. Results of the Heart Failure Registry
Language English Country England, Great Britain Media print-electronic
Document type Journal Article, Research Support, Non-U.S. Gov't
PubMed
31814303
PubMed Central
PMC6989281
DOI
10.1002/ehf2.12537
Knihovny.cz E-resources
- Keywords
- Acute Heart Failure, Heart Failure, Prognosis, Pulse pressure,
- MeSH
- Brachial Artery physiology MeSH
- Ventricular Dysfunction, Left physiopathology MeSH
- Blood Pressure physiology MeSH
- Middle Aged MeSH
- Humans MeSH
- Prognosis MeSH
- Prospective Studies MeSH
- Registries MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Heart Failure * diagnosis epidemiology mortality physiopathology MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
AIMS: To investigate the still uncertain independent prognostic impact of pulse pressure (PP) in acute heart failure (HF), in particular across the left ventricular ejection fraction (EF) phenotypes, and the potential contribution of PP in outlining the individual phenotypes. METHODS AND RESULTS: We prospectively evaluated 1-year death and rehospitalization in 4314 patients admitted for acute HF grouped by EF and stratified by their PP level on admission. In HF with reduced (< 40%) EF (HFrEF), the highest quartiles of PP had the lowest unadjusted [hazard ratio (HR) 0.77, 95% confidence interval (CI) 0.61-0.98] and adjusted (HR 0.64 0.50-0.82) risk of 1 year all cause death compared to the lowest quartile. Its prognostic impact was partially mediated by systolic blood pressure (SBP). In HF with preserved (≥ 50%) EF (HFpEF), the intermediate quartile of PP showed the lowest 1 year all cause mortality in unadjusted (HR 0.598, CI 0.416-0.858) and adjusted (HR 0.55, 95% CI 0.388-0.801) models with no relationship with SBP. In a receiver operating characteristic analysis, a combination of PP > 60 mmHg and SBP > 140 mmHg was associated to a preserved EF with a high performance value. No prognostic significance of PP was found in the HF with mid-range EF subgroup. CONCLUSIONS: In acute HFrEF, there is an almost linear inverse relation between mortality and PP, partly mediated by SBP. In HFpEF, a J-shaped relationship between mortality and PP was present with a better prognosis at the nadir. A combination of PP > 60 mmHg with SBP > 140 mmHg may be clinically helpful as marker of a preserved left ventricular EF.
ANMCO Research Center Florence Italy
Centro de Investigación en Red en Enfermedades Cardiovasculares A Coruña Spain
Heart Failure Unit Cardiac Department Guglielmo da Saliceto Hospital AUSL Piacenza Italy
Instituto de Investigación Biomédica A Coruña Spain
Institutul de Urgenta pentru Boli Cardiovasculare C C Iliescu Bucharest Romania
Maria Cecilia Hospital GVM Care and Research Cotignola Italy
San Raffaele Pisana Scientific Institute Rome Italy
Section of Cardiology Department of Medicine University of Verona Verona Italy
See more in PubMed
Paneni F, Diaz Cañestro C, Libby P, Lüscher TF, Camici GG. The aging cardiovascular system. Understanding it at the cellular and clinical levels. J Am Coll Cardiol 2017; 69: 1952–1967. PubMed
Arnold JMO, Marchiori GE, Imrie JR, Burton GL, Pflugfelder PW, Kostuk WJ. Large artery function in patients with chronic heart failure. Circulation 1991; 84: 2418–2425. PubMed
Benetos A, Safar M, Rudnichi A, Smulyan H, Richard JL, Ducimetieere P, Guize L. Pulse pressure: a predictor of long‐term cardiovascular mortality in a French male population. Hypertension 1997; 30: 1410–1415. PubMed
Selvaraj S, Steg PG, Elbez Y, Sorbets E, Feldman LJ, Eagle KA, Ohman EM, Blacher J, Bhatt DL. Pulse pressure and risk for cardiovascular events in patients with atherothrombosis from the REACH Registry. J Am Coll Cardiol 2016; 67: 392–403. PubMed
Chae CU, Pfeffer MA, Glynn RJ, Mitchell GF, Taylor JO, Hennekens CH. Increased pulse pressure and risk of heart failure in the elderly. JAMA 1999; 281: 634–639. PubMed
Mitchell GF, Moye LA, Brauwald E, Rouleau JL, Bernstein V, Geltman EM, Flaker GC, Pfeffer MA. Sphygmomanometrically determined pulse pressure is a powerful independent predictor of recurrent events after myocardial infarction in patients with impaired left ventricular function. SAVE investigators. Survival and Ventricular Enlargement. Circulation 1997; 96: 4254–4260. PubMed
Bonapace S, Rossi A, Cicoira M, Franceschini L, Golia G, Zanolla L, Marino P, Zardini P. Aortic distensibility independently affects exercise tolerance in patients with dilated cardiomyopathy. Circulation 2003; 107: 1603–1608. PubMed
Hundley WG, Kitzman DW, Morgan TM, Hamilton CA, Darty SN, Stewart KP, Herrington DM, Link KM, Little WC. Cardiac cycle‐dependent changes in aortic area and distensibility are reduced in older patients with isolated diastolic heart failure and correlate with exercise intolerance. J Am Coll Cardiol 2001; 38: 796–801. PubMed
Lam CSP, Teng THK. Minding the gap in heart failure: Understanding the pulse pressure in reduced versus preserved ejection fraction. JACC Heart Fail 2016; 4: 50–54. PubMed
Naka KK, Ikonomidis I. Brachial pulse pressure in heart failure: simple to measure but complex to interpret. Eur Heart J 2019; 40: e8–e10. PubMed
Aronson D, Burger AJ. Relation between pulse pressure and survival in patients with decompensated heart failure. Am J Cardiol 2004; 93: 785–788. PubMed
Jackson CE, Castagno D, Maggioni AP, Køber L, Squire IB, Swedberg K, Andersson B, Richards AM, Bayes‐Genis A, Tribouilloy C, Dobson J, Ariti CA, Poppe KK, Earle N, Whalley G, Pocock SJ, Doughty RN, McMurray JJ. Differing prognostic value of pulse pressure in patients with heart failure with reduced or preserved ejection fraction: results from the MAGGIC individual patient meta‐analysis. Eur Heart J 2015; 36: 1106–1114. PubMed
Laskey W, Wu J, Schulte P, Hernandez AF, Yancy CW, Heidenreich PA, Bhatt DL, Fonarow GC. The association of arterial pulse pressure with long‐term clinical outcomes in patients with heart failure. JACC Heart Fail 2016; 4: 42–49. PubMed
Tokitsu T, Yamamoto E, Hirata Y, Kusaka H, Koichiro FK, Sueta D, Sugamura K, Sakamoto K, Tsujita K, Kaikita K, Hokimoto S, Sugiyama S, Ogawa H. Clinical significance of pulse pressure in patients with heart failure with preserved left ventricular ejection fraction. Eur J Heart Fail 2016; 18: 1353–1361. PubMed
Chatterjee K, Massie B. Systolic and diastolic heart failure: Differences and similarities. J Card Fail 2007; 13: 569–576. PubMed
Chioncel O, Mebazaa A, Harjola VP, Coats AJ, Piepoli MF, Crespo‐Leiro MG, Laroche C, Seferovic PM, Anker SD, Ferrari R, Ruschitzka F, Lopez‐Fernandez S, Miani D, Filippatos G, Maggioni AP. Clinical phenotypes and outcome of patients hospitalized for acute heart failure: the ESC Heart Failure Long‐Term Registry. Eur J Heart Fail 2017; 19: 1242–1254. PubMed
Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, González‐Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016; 37: 2129–2200. PubMed
Lee TT, Chen J, Cohen DJ, Tsao L. The association between blood pressure and mortality in patients with heart failure. Am Heart J 2006; 151: 76–83. PubMed
Barlera S, Tavazzi L, Franzosi MG, Marchioli L, Raimondi E, Masson S, Urso R, Lucci D, Nicolosi GL, Maggioni AP, Tognoni G, GISSI HF Investigators . Predictors of mortality in 6975 patients with chronic heart failure in the Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardico‐Heart Failure trial: proposal for a nomogram. Circ Heart Fail 2013; 6: 31–39. PubMed
Maggioni AP, Anker SD, Dahlström U, Filippatos G, Ponikowski P, Zannad F, Amir O, Chioncel O, Leiro MC, Drodz J, Erglis A, Fazlibegovic E, Fonseca C, Fruhwald F, Gatzov P, Goncalvesova E, Hassanein M, Hradec J, Kavoliuniene A, Lainscak M, Logeart D, Merkely B, Metra M, Persson H, Seferovich P, Temizhan A, Tousoulis D, Tavazzi L, Heart Failure Association of the ESC . Are hospitalized or ambulatory patients with heart failure treated in accordance with European Society of Cardiology guidelines? Evidence from 12440 patients of the ESC Heart Failure Long‐Term Registry. Eur J Heart Fail 2013; 15: 1173–1184. PubMed
Tsao CW, Lyass A, Larson MG, Levy D, Hamburg NM, Vita JA, Benjamin EJ, Mitchell GF, Vasan RS. Relation of central arterial stiffness to incident heart failure in the community. J Am Heart Assoc 2015; 4: e002189. PubMed PMC
Chirinos JA, Kips JG, Jacobs DR Jr, Brumback L, Duprez DA, Kronmal R, Bluemke DA, Townsend RR, Vermeersch S, Segers P. Arterial wave reflections and incident cardiovascular events and heart failure: MESA (Multiethnic Study of Atherosclerosis). J Am Coll Cardiol 2012; 60: 2170–2177. PubMed PMC
Domanski MJ, Mitchell GF, Norman JE, Exner DV, Pitt B, Pfeffer MA. Independent prognostic information provided by sphymomanometrically determined pulse pressure and mean arterial pressure in patients with left ventricular dysfunction. J Am Coll Cardiol 1999; 33: 951–958. PubMed
Voors AA, Petrie CJ, Petrie MC, Charlesworth A, Hillege HL, Zijlstra F, McMurray JJ, van Veldhuisen DJ. Low pulse pressure is independently related to elevated natriuretic peptides and increased mortality in advanced chronic heart failure. Eur Heart J 2005; 26: 1759–1764. PubMed
Petrie CJ, Voors AA, van Veldhuisen DJ. Low pulse pressure is an independent predictor of mortality and morbidity in non ischaemic, but not in ischaemic advanced heart failure patients. Int J Cardiol 2009; 131: 336–344. PubMed
Maeder MT, Kaye DM. Differential impact of heart rate and blood pressure on outcome in patients with heart failure with reduced versus preserved left ventricular ejection fraction. Int J Cardiol 2012; 155: 249–256. PubMed
O'Connor CM, Mentz RJ, Cotter G, Metra M, Cleland JG, Davison BA, Givertz MM, Mansoor GA, Ponikowski P, Teerlink JR, Voors AA, Fiuzat M, Wojdyla D, Chiswell K, Massie BM. The PROTECT in‐hospital risk model: 7‐day outcome in patients hospitalized with acute heart failure and renal dysfunction. Eur J Heart Fail 2012; 14: 605–612. PubMed
Parissis JT, Ikonomidis I, Rafouli‐Stergiou P, Mebazaa A, Delgado J, Farmakis D, Vilas‐Boas F, Paraskevaidis I, Anastasiou‐Nana M, Follath F. Clinical characteristics and predictors of in‐hospital mortality in acute heart failure with preserved left ventricular ejection fraction. Am J Cardiol 2011; 107: 79–84. PubMed
Weber T, Chirinos JA. Pulsatile arterial haemodynamics in heart failure. Eur Heart J 2018. Nov 14; 39: 3847–3854. PubMed PMC
Sung SH, Yu WC, Cheng HM, Chuang SY, Wang KL, Huang CM, Chen CH. Pulsatile hemodynamics and clinical outcomes in acute heart failure. Am J Hypertens 2011; 24: 775–782. PubMed
Borlaug BA, Olson TP, Lam CS, Flood KS, Johnson BD, Redfield MM. Global cardiovascular reserve dysfunction in heart failure with preserved ejection fraction. J Am Coll Cardiol 2010; 56: 845–854. PubMed PMC
Regnault V, Lagrange J, Pizard A, Safar ME, Fay R, Pitt B, Challande P, Rossignol P, Zannad F, Lacolley P. Opposite predictive value of pulse pressure and aortic pulse wave velocity on heart failure with reduced left ventricular ejection fraction: insights from an Eplerenone Post‐Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS) substudy. Hypertension 2014; 63: 105–111. PubMed
Reddy YNV, Andersen MJ, Obokata M, Katlyn E, Koepp KE, Garvan C, Kane GC, Melenovsky V, Olson TP, Borlaug BA. Arterial stiffening with exercise in patients with heart failure and preserved ejection fraction. J Am Coll Cardiol 2017; 70: 136–148. PubMed PMC
Stevenson LW, Perloff JK. The limited reliability of physical signs for estimating hemodynamics in chronic heart failure. JAMA 1989; 261: 884–888. PubMed
Williams B, Lacy PS, Thom SM, Cruickshank K, Stanton A, Collier D, Hughes AD, Thurston H, O'Rourke M, CAFE Investigators , Anglo‐Scandinavian Cardiac Outcomews Triale Investigators , CAFE Steering Committee and Writing Committee . Differetial impact of blood pressure‐lowering drugs on central aortic pressure and clinical outcomes: principal results of the Conduit Artery Function Evaluation (CAFE) study. Circulation 2006; 113: 1213–1225. PubMed
Bonapace S, Rossi A, Cicoira M, Targher G, Valbusa F, Benetos A. Increased aortic pulse wave velocity as measured by echocardiography is strongly associated with poor prognosis in patients with heart failure. J Am Soc Echocardiogr 2013; 26: 714–720. PubMed