Pulse pressure predicts prognosis in heart failure independent of invasive hemomdynamic parameters

Abstract

Background: Pulse pressure (PP) is positively correlated with mortality in patients with hypertension. The association between PP and prognosis in patients with HF has not been systematically investigated. Methods: Our study analyzed 1879 systolic HF patients (age 52±13, LVEF 22±7, 60% NYHA IV) referred to a single university center for HF management and heart transplant evaluation between 1983 and 2003. Blood pressure, along with invasive hemodynamic variables, were prospectively recorded after implementation of HF medical therapy. Patients were analyzed by quartiles of systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP). Results: Patients with narrower PP were younger, had significantly lower LVEF and cardiac index, and higher pulmonary artery and pulmonary capillary wedge pressure (PCW). Decreased PP quartile was associated with male gender, lower Na and total cholesterol levels, and lower body mass index. Patients in lower PP quartiles were less likely to have history of hypertension or diabetes, and less likely to be treated with ACEIs and statins. PP quartiles were similar in terms of CAD, beta-blocker therapy, and levels of TnI, BNP, and Cr. Higher quartiles of PP were associated with significantly improved 1-yr survival, similar to the trends seen with SBP and DBP (Figure). Receiver operator curve analysis showed PP provided a similar degree of prognostic information as cardiac index (0.54 vs. 0.57, respectively) After adjustment for sex, age, CAD, LVEF, PCW and cardiac index, relative risk of death at 1 year per each 10 mmHg increase in PP was 0.88 95% CI 0.80-0.98) (p<0.02). Conclusions: Narrowed pulse pressure is associated with worsened outcomes in heart failure. Pulse pressure represents a simple noninvasive predictor of heart failure prognosis, providing information independent of invasive hemodynamic parameters and other heart failure prognostic factors .