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Background: Patients with heart failure (HF) have diminished exercise capacity resulting in-part from lower peak-exercise cardiac output, which is associated with poor outcomes. Proportional pulse pressure (PPP), a ratio of pulse pressure and systolic blood pressure, is a surrogate for stroke volume. This study aimed to investigate relationships between PPP and exercise tolerance, and prognostic impact of PPP on patients with HF with reduced ejection fraction (HFrEF).
Methods and Results: PPP were calculated in 2125 HFrEF patients randomized in the HF-ACTION. We assessed the relationship of PPP to exercise tolerance and mortality. In our study cohorts, the median PPP was 37.8% (interquartile range: 32.8 to 42.9%). Higher PPP was associated with shorter 6-minute walking distance and lower peak VO2 (both P<0.001). There were 351 deaths during median follow-up of 936 days. Higher PPP was associated with poorer survivals (Quartile-4 versus 1: hazard ratio [95% confidence interval] 1.41 [1.06 to 1.87], P = 0.019). PPP had a curvilinear association with mortality, which became particularly apparent when PPP was >38.0% (Figure). Among patients who had PPP >38.0%, PPP as a continuous value remained independently associated with mortality (1.03 [1.00 to 1.06], P = 0.044) in multivariable analyses.
Conclusions: PPP had a curvilinear association with mortality in patients with HFrEF. Among patients with PPP >38.0%, higher PPP was associated with poorer exercise tolerance and higher mortality.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Making Progress in Understanding Heart Failure
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1123-277
- 2017 American College of Cardiology Foundation