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Review
. 2015 May 7;36(18):1106-14.
doi: 10.1093/eurheartj/ehu490. Epub 2015 Jan 23.

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

Colette E Jackson  1 , Davide Castagno  2 , Aldo P Maggioni  3 , Lars Køber  4 , Iain B Squire  5 , Karl Swedberg  6 , Bert Andersson  7 , A Mark Richards  8 , Antoni Bayes-Genis  9 , Christophe Tribouilloy  10 , Joanna Dobson  11 , Cono A Ariti  11 , Katrina K Poppe  12 , Nikki Earle  12 , Gillian Whalley  13 , Stuart J Pocock  11 , Robert N Doughty  12 , John J V McMurray  14 ; Meta-Analysis Global Group in Chronic Heart Failure MAGGIC
Collaborators, Affiliations
Free article
Review

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

Colette E Jackson et al. Eur Heart J. .
Free article

Abstract

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.

Keywords: Heart failure; Mortality; Preserved ejection fraction; Pulse pressure; Reduced ejection fraction.

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