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
European Heart Journal
Abstract
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.
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.
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.
Contributors
Colette E. Jackson
Author
University of Glasgow Glasgow , United Kingdom of Great Britain & Northern Ireland
Davide Castagno
Author
Aldo P. Maggioni
Author
Lars Køber
Author
Iain B. Squire
Author
Karl Swedberg
Author
Bert Andersson
Author
A. Mark Richards
Author
Antoni Bayes-Genis
Author
Christophe Tribouilloy
Author
Joanna Dobson
Author
Cono A. Ariti
Author
Katrina K. Poppe
Author
Nikki Earle
Author
Gillian Whalley
Author
Stuart J. Pocock
Author
Robert N. Doughty
Author
John J.V. McMurray
Author
C. Berry
Author
R. Doughty
Author
C. Granger
Author
L. Køber
Author
B. Massie
Author
F. McAlister
Author
J. McMurray
Author
S. Pocock
Author
K. Poppe
Author
K. Swedberg
Author
J. Somaratne
Author
G. Whalley
Author
A. Ahmed
Author
B. Andersson
Author
A. Bayes-Genis
Author
C. Berry
Author
M. Cowie
Author
R. Cubbon
Author
R. Doughty
Author
J. Ezekowitz
Author
J. Gonzalez-Juanatey
Author
M. Gorini
Author
I. Gotsman
Author
L. Grigorian-Shamagian
Author
M. Guazzi
Author
M. Kearney
Author
L. Køber
Author
M. Komajda
Author
A. di Lenarda
Author
M. Lenzen
Author
D. Lucci
Author
S. Macín
Author
B. Madsen
Author
A. Maggioni
Author
M. Martínez-Sellés
Author
F. McAlister
Author
F. Oliva
Author
K. Poppe
Author
M. Rich
Author
M. Richards
Author
M. Senni
Author
I. Squire
Author
G. Taffet
Author
L. Tarantini
Author
C. Tribouilloy
Author
R. Troughton
Author
H. Tsutsui
Author
G. Whalley
Author
R. Doughty
Author
N. Earle
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G.D. Gamble
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K. Poppe
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G. Whalley
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C. Ariti
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J. Dobson
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S. Pocock
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K. Poppe
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R.N. Doughty
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G. Whalley
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B. Andersson
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C. Hall
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A.M. Richards
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R. Troughton
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J. Lainchbury
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C. Berry
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K. Hogg
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J. Norrie
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K. Stevenson
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M. Brett
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J. McMurray
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M.A. Pfeffer
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K. Swedberg
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C.B. Granger
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P. Held
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J.J.V. McMurray
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E.L. Michelson
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P.J.M.J. Vantrimpont
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K. Swedberg
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