Different relationships between pulse pressure and mortality in heart failure with reduced, mid-range and preserved ejection fraction

Tiew Hwa Katherine Teng, Wan Ting Tay, Ulf Dahlstrom, Lina Benson, Carolyn S.P. Lam, Lars H. Lund

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3 Citations (Scopus)

Abstract

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, < 40%), mid-range (HFmrEF, 40–49%) and preserved EF (HFpEF, ≥ 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 (pinteraction = 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.

Original languageEnglish
Pages (from-to)203-209
Number of pages7
JournalInternational Journal of Cardiology
Volume254
DOIs
Publication statusPublished - 1 Mar 2018

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Heart Failure
Blood Pressure
Mortality
Vascular Stiffness
Left Ventricular Function
Registries
Outpatients
Logistic Models

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title = "Different relationships between pulse pressure and mortality in heart failure with reduced, mid-range and preserved ejection fraction",
abstract = "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, < 40{\%}), mid-range (HFmrEF, 40–49{\%}) and preserved EF (HFpEF, ≥ 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 (pinteraction = 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.",
keywords = "Heart failure, Mid-range ejection fraction, Outcomes, Preserved ejection fraction, Pulse pressure, Reduced ejection fraction",
author = "Teng, {Tiew Hwa Katherine} and Tay, {Wan Ting} and Ulf Dahlstrom and Lina Benson and Lam, {Carolyn S.P.} and Lund, {Lars H.}",
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Different relationships between pulse pressure and mortality in heart failure with reduced, mid-range and preserved ejection fraction. / Teng, Tiew Hwa Katherine; Tay, Wan Ting; Dahlstrom, Ulf; Benson, Lina; Lam, Carolyn S.P.; Lund, Lars H.

In: International Journal of Cardiology, Vol. 254, 01.03.2018, p. 203-209.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Different relationships between pulse pressure and mortality in heart failure with reduced, mid-range and preserved ejection fraction

AU - Teng, Tiew Hwa Katherine

AU - Tay, Wan Ting

AU - Dahlstrom, Ulf

AU - Benson, Lina

AU - Lam, Carolyn S.P.

AU - Lund, Lars H.

PY - 2018/3/1

Y1 - 2018/3/1

N2 - 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, < 40%), mid-range (HFmrEF, 40–49%) and preserved EF (HFpEF, ≥ 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 (pinteraction = 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.

AB - 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, < 40%), mid-range (HFmrEF, 40–49%) and preserved EF (HFpEF, ≥ 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 (pinteraction = 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.

KW - Heart failure

KW - Mid-range ejection fraction

KW - Outcomes

KW - Preserved ejection fraction

KW - Pulse pressure

KW - Reduced ejection fraction

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