Abstract 11462: The Clinical Significance of Pulse Pressure in Patients With Heart Failure With Preserved Ejection Fraction

Abstract

Background: Although pulse pressure (PP) has been recognized as a risk factor for various cardiovascular diseases, its association with cardiovascular outcomes in patients with heart failure (HF) with preserved ejection fraction (HFpEF) remains uncertain. This study aimed to assess the relationship between PP and cardiovascular outcomes in HFpEF patients. Methods: We enrolled 317 consecutive HFpEF patients, admitted to Kumamoto University Hospital from 2007 to 2013. We measured blood pressure (BP) by using ankle brachial index (ABI) form on admission. PP values higher than 65 mmHg were defined as high-PP as reported previously. Results: PP had a significant positive correlation with pulse wave velocity (PWV) (r=0.50, p<0.001), and negative correlations with estimated glomerular filtration rate (eGFR) (r=0.32, p<0.001) and hemoglobin levels (r=0.27, p<0.01) in HFpEF patients. In multivariate logistic-regression analysis, age, hemoglobin, eGFR and the presence of diabetes mellitus were independently associated with high-PP. PP also had strong and significant correlations with eGFR, PWV and hemoglobin level. In multivariate-Cox-proportional hazard analysis, high-PP (p=0.01), the presence of ischemic heart disease (p=0.01), and B-type natriuretic peptide (BNP) values (p=0.01) were independently associated with the occurrence of cardiovascular events (CVE). In Kaplan-Meier analysis, HFpEF patients with high-PP had a significant higher risk of CVE and HF-related events (both, log-lank test, p<0.01). Multivariate-Cox-hazard analysis identified that high-PP, but not high-systolic BP (SBP), as an independent predictor of both CVE (hazard ratio [HR]: 2.15, p=0.01) and HF-related events (HR: 4.37, p<0.01).We further stratified patients into four groups combined with PP and BNP values, HFpEF patients with both high-PP and high-BNP(cutoff:100pg/dL) had the highest risk of HF-related events and CVE (both, log-rank test, p<0.001), indicating their usefulness in risk prediction in HFpEF patients. Conclusion: High-PP, rather than high-SBP, was closely associated with the prognosis of patients with HFpEF. PP is the useful marker for risk stratification in HFpEF.