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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

2015; Oxford University Press; Volume: 36; Issue: 18 Linguagem: Inglês

10.1093/eurheartj/ehu490

1522-9645

Chandler E. Jackson, Davide Castagno, Aldo P. Maggioni, Lars Køber, I B Squire, Karl Swedberg, Bert Andersson, Mark Richards, Antoni Bayés‐Genís, C. Tribouilloy, Joanna Dobson, Cono Ariti, Katrina Poppe, Nikki Earle, Gillian Whalley, S J Pocock, Robert N. Doughty, John J.V. McMurray, Meta-Analysis Global Group in Chronic Heart, Colin Berry, Robert N. Doughty, C. B. Granger, Lars Køber, B.M. Massie, Finlay A. McAlister, John J.V. McMurray, SJ Pocock, Katrina Poppe, Karl Swedberg, J. Somaratne, Gillian Whalley, Ali Ahmed, Bert Andersson, Antoni Bayés‐Genís, Colin Berry, Martín Cowie, Richard M. Cubbon, Robert N. Doughty, Justin A. Ezekowitz, José Ramón González–Juanatey, Marco Gorini, Israel Gotsman, Lilian Grigorian‐Shamagian, Marco Guazzi, Mark T. Kearney, Lars Køber, Michel Komajda, Andrea Di Lenarda, Mattie Lenzen, D. Lucci, Stella M. Macı́n, Bo Madsen, Aldo P. Maggioni, Manuel Martínez‐Sellés, Finlay A. McAlister, F. D. Oliva, Katrina Poppe, Michael W. Rich, Mark Richards, Michele Senni, I B Squire, George E. Taffet, Luigi Tarantini, C. Tribouilloy, Richard W. Troughton, H. Tsutsui, Gillian Whalley, Robert N. Doughty, Nikki Earle, G. Gamble, Katrina Poppe, Gillian Whalley, Cono Ariti, Joanna Dobson, SJ Pocock, Katrina Poppe, Robert N. Doughty, Gillian Whalley, Bert Andersson, Charles B. Hall, Mark Richards, Richard W. Troughton, John G. Lainchbury, Colin Berry, Karen Hogg, John Norrie, Karen Stevenson, Michael Brett, John J.V. McMurray, Marc A. Pfeffer, Karl Swedberg, C. B. Granger, Peter Held, John J.V. McMurray, Eric L. Michelson, Bertil Olofsson, Jan Östergren, Salim Yusuf, Lars Køber, Christian Torp‐Pedersen, Mattie Lenzen, Wilma J.M. Scholte op Reimer, E. Boersma, Pascal Vantrimpont, F Follath, Karl Swedberg, John G.F. Cleland, Michel Komajda, Israel Gotsman, Donna R. Zwas, David Planer, Tanya Azaz‐Livshits, Dan Admon, Chaim Lotan, Arnon Keren, Lilian Grigorian‐Shamagian, Alfonso Varela‐Román, Pilar Mazón‐Ramos, P. Rigeiro-Veloso, M. A. Bandin-Dieguez, José Ramón González–Juanatey, Marco Guazzi, J. Myers, Ross Arena, Finlay A. McAlister, Justin A. Ezekowitz, Paul W. Armstrong, Bibiana Čujec, D. Ian Paterson, Martín Cowie, D Wood, Andrew J.S. Coats, Simon G. Thompson, Vinay Suresh, P. A. Poole-Wilson, G C Sutton, Manuel Martínez‐Sellés, José Antonio García Robles, Luís Prieto, Marta Domínguez Muñoa, Elisa Frades, Óscar Dı́az-Castro, Jesús Almendral, Luigi Tarantini, Pompilio Faggiano, Michele Senni, D. Lucci, Daniele Bertoli, Maurizio Porcu, C. Opasich, Luigi Tavazzi, Aldo P. Maggioni, Vibeke Kirk, M. Bay, Jan Parner, Kim Krogsgaard, Tessa Herzog, Søren Boesgaard, Christian Hassager, Olav Wendelboe Nielsen, Jan Aldershvile, Henrik Nielsen, Lars Køber, Stella M. Macı́n, Enrico Perna, J. P. Cimbaro Canella, Pedro Alvarenga, Rolando Pantich, Nelson Ríos, Eduardo Farias, J BADARACCO, Bente Kühn Madsen, Jim Hansen, K. H. Stokholm, Jozien T. J. Brons, Dorte Husum, L. S. Mortensen, Antoni Bayés‐Genís, Rafael Vázquez, Teresa Puig, Carlos Fernández-Palomeque, Alfredo Bardajı́, Domingo A. Pascual‐Figal, Jordi Ordóñez‐Llanos, M. Valdés, Albert Gabarrús, Ricardo Pavón, Luis Pastor, José Ramón González–Juanatey, Jesús Almendral, Miquel Fiol, Vicente Nieto, Carlos Macaya, Juan Cinca, I. Cygankiewitz, A. Bayes de Luna, J. D. Newton, Hanna Blackledge, I B Squire, S. Wright, Gillian Whalley, Robert N. Doughty, Roger Kerzner, Brian F. Gage, Kenneth E. Freedland, Michael W. Rich, Bao Huynh, Aleksandr Rovner, Kenneth E. Freedland, R. M. Carney, Michael W. Rich, George E. Taffet, T. A. Teasdale, Anthony J. Bleyer, Nicholas Kutka, Robert J. Luchi, C. Tribouilloy, Dan Ruşinaru, Haïfa Mahjoub, Vicky Soulière, Freda L. Levy, M. Peltier, H. Tsutsui, Masayuki Tsuchihashi, Atsushi Takeshita, Philip MacCarthy, Mark T. Kearney, James Nolan, A. J. Lee, Richard Prescott, Amil M. Shah, W Paul Brooksby, Keith A.A. Fox, Alfonso Varela‐Román, José Ramón González–Juanatey, P. Basante, Ramiro Trillo, Javier García‐Seara, José Luis Martínez‐Sande, Francisco Gudé,

Hemodynamic Monitoring and Therapy

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. 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. 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.