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Different relationships between pulse pressure and mortality in heart failure with reduced, mid-range and preserved ejection fraction
Natl Heart Ctr Singapore, Singapore; Univ Western Australia, Australia.
Natl Heart Ctr Singapore, Singapore.
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.ORCID iD: 0000-0001-6353-8041
Karolinska Inst, Sweden.
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2018 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 254, p. 203-209Article in journal (Refereed) Published
Abstract [en]

Objectives/Background: In heart failure (HF), pulse pressure (PP) may reflect both vascular stiffness and left ventricular function, but its prognostic role in relation to ejection fraction (EF) is poorly understood. Methods: In the Swedish Heart Failure Registry, we investigated the association between PP and 1-year mortality in patients with HF and reduced (HFrEF, amp;lt;40%), mid-range (HFmrEF, 40-49%) and preserved EF (HFpEF, amp;gt;= 50%), using multivariable logistic regression and restricted cubic splines. Results: Among 36,770 patients discharged alive or enrolled as out-patients with 1-year follow-up (mean age 74 +/- 12 years, 63% men, 56% HFrEF, 21% HFmrEF, 23% HFpEF), crude one-year mortality was 18%. Mean PP increased across EF groups: 51 +/- 16 in HFrEF, 57 +/- 18 in HFmrEF, 60 +/- 19 mm Hg in HFpEF. In crude regression splines, the association between PP and mortality was U-shaped in HFmrEF and HFpEF, but curvilinear with only low PP associated with mortality in HFrEF. In multivariable analyses, a significant interaction by EF group and PP was observed (p(interaction) = 0.015): low PP was associated with higher mortality in HFrEF (adjusted OR [1st vs. 4th quintile] = 1.40, 95% CI 1.18-1.67) and HFpEF (1.43, 1.14-1.81) but only by trend in HFmrEF; high PP had a trend towards higher mortality in HFmrEF (5th vs. 3rd quintile = 1.30, 1.00-1.69) and HFpEF (1.25, 0.98-1.61). Conclusions: The association between PP and mortality in HF was influenced by EF. Low PP was independently associated with mortality in HFrEF and HFpEF and by trend in HFmrEF. High PP was independently associated with mortality by trend in HFmrEF and HFpEF. (C) 2017 Elsevier B.V. All rights reserved.

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD , 2018. Vol. 254, p. 203-209
Keywords [en]
Pulse pressure; Heart failure; Reduced ejection fraction; Preserved ejection fraction; Mid-range ejection fraction; Outcomes
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:liu:diva-145441DOI: 10.1016/j.ijcard.2017.09.187ISI: 000424514800047PubMedID: 29407092OAI: oai:DiVA.org:liu-145441DiVA, id: diva2:1192915
Note

Funding Agencies|Swedish National Board of Health and Welfare; Swedish Association of Local Authorities and Regions; Swedish Society of Cardiology; SwedeHF Research Foundation; Swedish Research Council [2013-23897-104604-23, 523-2014-2336]; Swedish Heart Lung Foundation [20100419, 20120321]; Stockholm County Council [20110120, 20140220]; Swedish Society of Medicine [174111, 504881]; Swedish Heart-Lung Foundation [20150528]; Karolinska Institutet Foundation and Funds [40842]; Mats Kleberg Foundation [2015-00097, 2016-00015]; National Medical Research Council Singapore

Available from: 2018-03-23 Created: 2018-03-23 Last updated: 2018-03-23

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Division of Cardiovascular MedicineFaculty of Medicine and Health SciencesDepartment of Cardiology in Linköping
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