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

TY - JOUR

T1 - Differing prognostic value of pulse pressure in patients with heart failure with reduced or preserved ejection fraction

T2 - results from the MAGGIC individual patient meta-analysis

AU - Jackson, Colette E

AU - Castagno, Davide

AU - Maggioni, Aldo P

AU - Køber, Lars

AU - Squire, Iain B

AU - Swedberg, Karl

AU - Andersson, Bert

AU - Richards, A Mark

AU - Bayes-Genis, Antoni

AU - Tribouilloy, Christophe

AU - Dobson, Joanna

AU - Ariti, Cono A

AU - Poppe, Katrina K

AU - Earle, Nikki

AU - Whalley, Gillian

AU - Pocock, Stuart J

AU - Doughty, Robert N

AU - McMurray, John J V

AU - Meta-Analysis Global Group in Chronic Heart Failure MAGGIC

N1 - Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: [email protected].

PY - 2015/5/7

Y1 - 2015/5/7

N2 - 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.

AB - 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.

KW - Acute Disease

KW - Cause of Death

KW - Chronic Disease

KW - Female

KW - Heart Failure

KW - Humans

KW - Hypertension

KW - Male

KW - Middle Aged

KW - Observational Studies as Topic

KW - Prognosis

KW - Randomized Controlled Trials as Topic

KW - Stroke Volume

U2 - 10.1093/eurheartj/ehu490

DO - 10.1093/eurheartj/ehu490

M3 - Journal article

C2 - 25616644

SN - 0195-668X

VL - 36

SP - 1106

EP - 1114

JO - European Heart Journal

JF - European Heart Journal

ER -