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: 05/07/2015
Affiliation: BHF Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK.
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
Authors: Ahmed A, McAlister FA, Gamble GD, Thompson SG, Rich MW, Rich MW, Brett M, Wood DA, Doughty RN, Doughty RN, Doughty RN, McMurray JJ, McMurray JJ, Poppe KK, Whalley GA, Ezekowitz J, Ezekowitz J, Squire IB, Squire IB, Coats AJ, Andersson B, Andersson B, Andersson B, Pfeffer MA, Martínez-Sellés M, Martínez-Sellés M, Poppe K, Poppe K, Poppe K, Poppe K, Earle N, Earle N, Tribouilloy C, Tribouilloy C, Tribouilloy C, Swedberg K, Swedberg K, Swedberg K, Swedberg K, Køber L, Køber L, Køber L, Køber L, Berry C, Berry C, Berry C, Squire I, Whalley G, Whalley G, Whalley G, Whalley G, Whalley G, Hall C, Richards AM, Richards AM, Troughton R, Troughton R, Lainchbury J, Hogg K, Norrie J, Stevenson K, McMurray J, McMurray J, Granger CB, Michelson EL, Olofsson B, Yusuf S, Torp-Pedersen C, Lenzen MJ, Boersma E, Vantrimpont PJ, Follath F, Cleland J, Komajda M, Komajda M, Gotsman I, Gotsman I, Zwas D, Planer D, Azaz-Livshits T, Admon D, Lotan C, Keren A, Grigorian-Shamagian L, Grigorian-Shamagian L, Varela-Roman A, Varela-Roman A, Mazón-Ramos P, Rigeiro-Veloso P, Bandin-Dieguez MA, Gonzalez-Juanatey JR, Gonzalez-Juanatey JR, Gonzalez-Juanatey JR, Guazzi M, Guazzi M, Myers J, Arena R, Armstrong PW, Cujec B, Paterson I, Cowie MR, Suresh V, Poole-Wilson PA, Sutton GC, Robles JA, Prieto L, Muñoa MD, Frades E, Díaz-Castro O, Almendral J, Almendral J, Tarantini L, Tarantini L, Faggiano P, Senni M, Senni M, Lucci D, Lucci D, Bertoli D, Porcu M, Opasich C, Tavazzi L, Maggioni AP, 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, Bayes-Genis A, Bayes-Genis A, Vazquez R, Puig T, Fernandez-Palomeque C, Pascual-Figal D, Ordoñez-Llanos J, Valdes M, Gabarrus A, Pavon R, Pastor L, Fiol M, Nieto V, Macaya C, Cinca J, Bayes de Luna A, Newton JD, Blackledge HM, Wright SP, Kerzner R, Gage BF, Freedland KE, Freedland KE, Huynh BC, Rovner A, Carney RM, Taffet GE, Teasdale TA, Bleyer AJ, Kutka NJ, Luchi RJ, Rusinaru D, Mahjoub H, Soulière V, Lévy F, Peltier M, Tsutsui H, Tsutsui H, Tsuchihashi M, Takeshita A, MacCarthy PA, Kearney MT, Cubbon R, Nolan J, Lee AJ, Prescott RJ, Shah AM, Brooksby WP, Fox KA, Basante P, Trillo R, Garcia-Seara J, Martinez-Sande JL, Gude F, Pocock S, Pocock S, Doughty R, Doughty R, Doughty R, Granger C, Massie B, McAlister F, McAlister F, Somaratne J, Cowie M, Gonzalez-Juanatey J, Gorini M, Kearney M, di Lenarda A, Lenzen M, Macín S, Madsen B, Maggioni A, Oliva F, Rich M, Richards M, Taffet G, Ariti C, Dobson J, Dobson J, Held P, Scholte Op Reimer WJ, Bardají A, Pocock SJ, Ariti CA, Östergren J, Castagno D, Jackson CE, Cygankiewitz I
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.
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.