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

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Jackson, Colette E.
Castagno, Davide
Maggioni, A.P.
Køber, Lars
Squire, I.B.
Swedberg, Karl
Andersson, Bert
Richards, A.M.
Bayes-Genis, Antoni
Tribouilloy, Christophe
Dobson, Joanna
Ariti, Cono A.
Poppe, K.K.
Earle, Nikki
Whalley, Gillian
Pocock, Stuart J.
Doughty, Robert N.
McMurray, John J.V.
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Journal Article
Ngā Upoko Tukutuku (Māori subject headings)
pulse pressure
heart failure
reduced ejection fraction
preserved ejection fraction
Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC)
ANZSRC Field of Research Code (2020)
Jackson, C.E., Castagno, D., Maggioni, Aldo P., Køber, L., Squire, I.B., Swedburg, K., Anderssonn, B., Richards, M.A., Bayes-Genis, Tribouilloy, C., Dobson, J., Airiti, Cono A., Poppe, K.K., Earle, N., Whalley, G., Pocock, S.J., Doughty, R.N., and McMurray, J.J.V. doi:10.1093/eurheartj/ehu490
AIMS: Low pulse pressure is a marker of adverse outcome in patients with heart failure (HF) and reduced ejection fraction (HFREF) 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 HFPEF (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.
European Society of Cardiology
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