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
Por:
Jackson, CE, Castagno, D, Maggioni, AP, Kober, 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, JJV, Ordõez-Llanos J., Meta-Anal Global Grp Chronic He
Publicada:
7 may 2015
Resumen:
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.
Filiaciones:
Jackson, CE:
Univ Glasgow, BHF Cardiovasc Res Ctr, Glasgow G12 8TA, Lanark, Scotland
Castagno, D:
Univ Turin, Dept Med Sci, Citta Salute & Sci Hosp, Div Cardiol, Turin, Italy
Maggioni, AP:
Assoc Nazl Med Cardiol Osped Res Ctr, Florence, Italy
Kober, L:
Copenhagen Univ Hosp, Rigshosp, Dept Cardiol, Copenhagen, Denmark
Squire, IB:
Univ Leicester, Leicester, Leics, England
Glenfield Hosp, NIHR Biomed Res Unit, Leicester, Leics, England
Swedberg, K:
Univ London Imperial Coll Sci Technol & Med, Natl Heart & Lung Inst, London, England
Univ Gothenburg, Dept Mol & Clin Med, Gothenburg, Sweden
Andersson, B:
Univ Gothenburg, Dept Mol & Clin Med, Gothenburg, Sweden
Richards, AM:
Univ Otago, Dept Med, Christchurch, New Zealand
Natl Univ Heart Ctr, Singapore, Singapore
Bayes-Genis, A:
Hosp Badalona Germans Trias & Pujol, Heart Failure Unit, Badalona, Spain
Tribouilloy, C:
Univ Hosp Amiens, Dept Cardiol, Amiens, France
JulesVerne Univ Picardie, INSERM, U1088, Amiens, France
Dobson, J:
London Sch Hyg & Trop Med, Dept Med Stat, London WC1, England
Ariti, CA:
London Sch Hyg & Trop Med, Dept Med Stat, London WC1, England
Poppe, KK:
Univ Auckland, Dept Med, Auckland, New Zealand
Univ Auckland, Natl Inst Hlth Innovat, Auckland, New Zealand
Earle, N:
Univ Auckland, Dept Med, Auckland, New Zealand
Univ Auckland, Natl Inst Hlth Innovat, Auckland, New Zealand
Whalley, G:
Unitec Inst Technol, Auckland, New Zealand
Pocock, SJ:
London Sch Hyg & Trop Med, Dept Med Stat, London WC1, England
Doughty, RN:
Univ Auckland, Dept Med, Auckland, New Zealand
Univ Auckland, Natl Inst Hlth Innovat, Auckland, New Zealand
McMurray, JJV:
Univ Glasgow, BHF Cardiovasc Res Ctr, Glasgow G12 8TA, Lanark, Scotland
Ordõez-Llanos J.:
Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
Bronze, Green Published
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