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Background: The pathophysiology of heart failure with preserved ejection fraction (HFpEF) is still poorly understood, and the phenotype diversity of HFpEF has not been fully addressed. Proportional pulse pressure (PPP), the ratio of pulse pressure to systolic blood pressure, is positively correlated with invasively measured stroke volume. However, its prognostic significance is unknown in HFpEF patients, although it was predicted that lower PPP would be associated with poorer outcomes.
Methods and Results: PPP were calculated in 3441 HFpEF patients randomized in the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (TOPCAT) Trial. In our study cohort (the mean age was 69±10 years and 51 % were female), the median PPP was 40.0% (interquartile range: 36.3 to 45.5%). There were 529 deaths during median follow-up of 3.4 years. Higher PPP was associated with poor long-term survival (Quartile-4 versus 1: hazard ratio [95% confidence interval] 1.84 [1.59 to 2.09], P < 0.001). After multivariable risk adjustment, PPP remained independently associated with mortality (1.34 [1.12 to 2.57], P = 0.002). PPP showed a reverse curvilinear association with mortality, which became particularly apparent when PPP was >38.0% (Figure). No significant interaction effects were found between PPP and systolic blood pressure, heart rate and peripheral artery disease.
Conclusions: Contrary to expectations, higher PPP was associated with increased mortality risk in patients with HFpEF.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Emerging Developments in HFpEF and Arryhthmias
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1250-269
- 2017 American College of Cardiology Foundation