Brachial pulse pressure in acute heart failure. Results of the Heart Failure Registry
Abstract 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 res...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2019-12-01
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| Series: | ESC Heart Failure |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ehf2.12537 |
| _version_ | 1818387689109454848 |
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| author | Stefano Bonapace Andrea Rossi Cécile Laroche Maria G. Crespo‐Leiro Massimo F. Piepoli Andrew J.S. Coats Ulf Dahlström Filip Malek Cezar Macarie Pier Luigi Temporelli Aldo P. Maggioni Luigi Tavazzi the European Society of Cardiology Heart Failure Long‐Term Registry Investigators group |
| author_facet | Stefano Bonapace Andrea Rossi Cécile Laroche Maria G. Crespo‐Leiro Massimo F. Piepoli Andrew J.S. Coats Ulf Dahlström Filip Malek Cezar Macarie Pier Luigi Temporelli Aldo P. Maggioni Luigi Tavazzi the European Society of Cardiology Heart Failure Long‐Term Registry Investigators group |
| author_sort | Stefano Bonapace |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-12-14T04:13:56Z |
| format | Article |
| id | doaj.art-f3f08212f6bd41f0b6c49359e54e7fc7 |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-12-14T04:13:56Z |
| publishDate | 2019-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-f3f08212f6bd41f0b6c49359e54e7fc72022-12-21T23:17:36ZengWileyESC Heart Failure2055-58222019-12-01661167117710.1002/ehf2.12537Brachial pulse pressure in acute heart failure. Results of the Heart Failure RegistryStefano Bonapace0Andrea Rossi1Cécile Laroche2Maria G. Crespo‐Leiro3Massimo F. Piepoli4Andrew J.S. Coats5Ulf Dahlström6Filip Malek7Cezar Macarie8Pier Luigi Temporelli9Aldo P. Maggioni10Luigi Tavazzi11the European Society of Cardiology Heart Failure Long‐Term Registry Investigators groupUnità Complessa di Cardiologia Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Sacro Cuore don Calabria Negrar ItalySection of Cardiology, Department of Medicine University of Verona Verona ItalyEURObservational Research Programme Department European Society of Cardiology Sophia Antipolis FranceUnidad de Insuficiencia Cardiaca y Trasplante Cardiaco Complexo Hospitalario Universitario A Coruna A Coruña SpainHeart Failure Unit, Cardiac Department Guglielmo da Saliceto Hospital AUSL Piacenza ItalySan Raffaele Pisana Scientific Institute Rome ItalyDivision of Cardiology, Department of Medical and Health Sciences Linköping University Linköping SwedenHeart Failure and Hypertension Clinic Na Homolce Hospital Cardiovascular Center Prague Czech RepublicInstitutul de Urgenta pentru Boli Cardiovasculare C.C. Iliescu Bucharest RomaniaDivision of Cardiology Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico Veruno ItalyEURObservational Research Programme Department European Society of Cardiology Sophia Antipolis FranceMaria Cecilia Hospital GVM Care&Research Cotignola ItalyAbstract 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.https://doi.org/10.1002/ehf2.12537Pulse pressureHeart FailureAcute Heart FailurePrognosis |
| spellingShingle | Stefano Bonapace Andrea Rossi Cécile Laroche Maria G. Crespo‐Leiro Massimo F. Piepoli Andrew J.S. Coats Ulf Dahlström Filip Malek Cezar Macarie Pier Luigi Temporelli Aldo P. Maggioni Luigi Tavazzi the European Society of Cardiology Heart Failure Long‐Term Registry Investigators group Brachial pulse pressure in acute heart failure. Results of the Heart Failure Registry ESC Heart Failure Pulse pressure Heart Failure Acute Heart Failure Prognosis |
| title | Brachial pulse pressure in acute heart failure. Results of the Heart Failure Registry |
| title_full | Brachial pulse pressure in acute heart failure. Results of the Heart Failure Registry |
| title_fullStr | Brachial pulse pressure in acute heart failure. Results of the Heart Failure Registry |
| title_full_unstemmed | Brachial pulse pressure in acute heart failure. Results of the Heart Failure Registry |
| title_short | Brachial pulse pressure in acute heart failure. Results of the Heart Failure Registry |
| title_sort | brachial pulse pressure in acute heart failure results of the heart failure registry |
| topic | Pulse pressure Heart Failure Acute Heart Failure Prognosis |
| url | https://doi.org/10.1002/ehf2.12537 |
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