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.

Pubmed ID: 25616644

Journal: European heart journal

Publication Date: May 7, 2015

MeSH Terms: Humans, Male, Female, Middle Aged, Hypertension, Randomized Controlled Trials as Topic, Chronic Disease, Heart Failure, Cause of Death, Prognosis, Stroke Volume, Acute Disease, Observational Studies as Topic

Grants: FS/12/80/29821

Authors: Jackson CE, Castagno D, Maggioni AP, Køber L, Squire IB, Swedberg K, Andersson B, Richards AM, Bayes-Genis A, Tribouilloy C, Dobson J, Ariti CA, Poppe KK, Earle N, Whalley G, Pocock SJ, Doughty RN, McMurray JJ, Berry C, Doughty R, Granger C, Køber L, Massie B, McAlister F, McMurray J, Pocock S, Poppe K, Swedberg K, Somaratne J, Whalley G, Ahmed A, Andersson B, Bayes-Genis A, Berry C, Cowie M, Cubbon R, Doughty R, Ezekowitz J, Gonzalez-Juanatey J, Gorini M, Gotsman I, Grigorian-Shamagian L, Guazzi M, Kearney M, Køber L, Komajda M, di Lenarda A, Lenzen M, Lucci D, Macín S, Madsen B, Maggioni A, Martínez-Sellés M, McAlister F, Oliva F, Poppe K, Rich M, Richards M, Senni M, Squire I, Taffet G, Tarantini L, Tribouilloy C, Troughton R, Tsutsui H, Whalley G, Doughty R, Earle N, Gamble GD, Poppe K, Whalley G, Ariti C, Dobson J, Pocock S, Poppe K, Doughty RN, Whalley G, Andersson B, Hall C, Richards AM, Troughton R, Lainchbury J, Berry C, Hogg K, Norrie J, Stevenson K, Brett M, McMurray J, Pfeffer MA, Swedberg K, Granger CB, Held P, McMurray JJ, Michelson EL, Olofsson B, Östergren J, Yusuf S, Køber L, Torp-Pedersen C, Lenzen MJ, Scholte Op Reimer WJ, Boersma E, Vantrimpont PJ, Follath F, Swedberg K, Cleland J, Komajda M, Gotsman I, Zwas D, Planer D, Azaz-Livshits T, Admon D, Lotan C, Keren A, Grigorian-Shamagian L, Varela-Roman A, Mazón-Ramos P, Rigeiro-Veloso P, Bandin-Dieguez MA, Gonzalez-Juanatey JR, Guazzi M, Myers J, Arena R, McAlister FA, Ezekowitz J, Armstrong PW, Cujec B, Paterson I, Cowie MR, Wood DA, Coats AJ, Thompson SG, Suresh V, Poole-Wilson PA, Sutton GC, Martínez-Sellés M, Robles JA, Prieto L, Muñoa MD, Frades E, Díaz-Castro O, Almendral J, Tarantini L, Faggiano P, Senni M, Lucci D, Bertoli D, Porcu M, Opasich C, Tavazzi L, Maggioni AP, Kirk V, Bay M, Parner J, Krogsgaard K, Herzog TM, Boesgaard S, Hassager C, Nielsen OW, Aldershvile J, Nielsen H, Kober L, Macín SM, Perna ER, Cimbaro Canella JP, Alvarenga P, Pantich R, Ríos N, Farias EF, Badaracco JR, Madsen BK, Hansen JF, Stokholm KH, Brons J, Husum D, Mortensen LS, Bayes-Genis A, Vazquez R, Puig T, Fernandez-Palomeque C, Bardají A, Pascual-Figal D, Ordoñez-Llanos J, Valdes M, Gabarrus A, Pavon R, Pastor L, Gonzalez-Juanatey JR, Almendral J, Fiol M, Nieto V, Macaya C, Cinca J, Cygankiewitz I, Bayes de Luna A, Newton JD, Blackledge HM, Squire IB, Wright SP, Whalley GA, Doughty RN, Kerzner R, Gage BF, Freedland KE, Rich MW, Huynh BC, Rovner A, Freedland KE, Carney RM, Rich MW, Taffet GE, Teasdale TA, Bleyer AJ, Kutka NJ, Luchi RJ, Tribouilloy C, Rusinaru D, Mahjoub H, Soulière V, Lévy F, Peltier M, Tsutsui H, Tsuchihashi M, Takeshita A, MacCarthy PA, Kearney MT, Nolan J, Lee AJ, Prescott RJ, Shah AM, Brooksby WP, Fox KA, Varela-Roman A, Gonzalez-Juanatey JR, Basante P, Trillo R, Garcia-Seara J, Martinez-Sande JL, Gude F

Cite As: Jackson CE, Castagno D, Maggioni AP, Køber L, Squire IB, Swedberg K, Andersson B, Richards AM, Bayes-Genis A, Tribouilloy C, Dobson J, Ariti CA, Poppe KK, Earle N, Whalley G, Pocock SJ, Doughty RN, McMurray JJ, Meta-Analysis Global Group in Chronic Heart Failure MAGGIC. 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. Eur Heart J 2015 May 7;36(18):1106-14. Epub 2015 Jan 23.

Studies:

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.