PMID- 30801690
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230123
IS  - 1365-2362 (Electronic)
IS  - 0014-2972 (Linking)
VI  - 49
IP  - 6
DP  - 2019 Jun
TI  - Pulse pressure and prognosis in patients with heart failure with reduced ejection 
      fraction.
PG  - e13092
LID - 10.1111/eci.13092 [doi]
AB  - BACKGROUND: A high pulse pressure (PP) is associated with adverse cardiovascular 
      (CV) outcomes; however, this relationship may be reversed in patients with heart 
      failure with reduced ejection fraction (HFREF). METHODS: Patients from the WARCEF 
      trial with left ventricular ejection fraction </=35% were included. PP was divided 
      into tertiles: </=42, 42-54 and >54 mm Hg. Age and ejection fraction adjusted 
      Kaplan-Meier curves were generated to evaluate the relationship between PP and 
      outcomes [mortality, CV mortality, stroke and HF hospitalizations (HFH)]. Cox 
      proportional hazards models were created incorporating PP as a continuous 
      variable. The interaction of PP with New York Heart Association (NYHA) functional 
      class was examined. Linear and restricted cubic splines were used to study 
      nonlinear association between PP and outcomes. RESULTS: We included 2,299 
      patients with a mean(+/-SD) follow-up of 3.5 +/- 1.8 years. The lowest tertile of PP 
      (</=42 mm Hg) was associated with significantly higher CV mortality and HFH. Cox 
      proportional hazards models showed a reduction in CV death and HFH with higher 
      PP, with adjusted hazard ratios (HR) of 0.91 (P = 0.02) and 0.93 (P = 0.04) per 
      10 mm Hg increase in PP. This relationship was more pronounced in subjects with 
      NYHA functional class III-IV. Spline analysis showed that the association between 
      PP and CV mortality and HFH was only seen at PP values lower than 40 mm Hg. 
      CONCLUSIONS: In patients with advanced HFREF, a low PP (<40 mm Hg) portends a 
      worse prognosis, whereas a high PP (>50 mm Hg) predicts a relatively favourable 
      prognosis.
CI  - (c) 2019 Stichting European Society for Clinical Investigation Journal Foundation.
FAU - Shah, Neeraj
AU  - Shah N
AUID- ORCID: 0000-0001-5084-711X
AD  - Department of Cardiology, Lehigh Valley Health Network, Allentown, Pennsylvania.
FAU - Qian, Min
AU  - Qian M
AD  - Columbia University Medical Center, New York, New York.
FAU - Di Tullio, Marco R
AU  - Di Tullio MR
AD  - Columbia University Medical Center, New York, New York.
FAU - Graham, Susan
AU  - Graham S
AD  - The State University of New York at Buffalo, Buffalo, New York.
FAU - Mann, Douglas L
AU  - Mann DL
AD  - Washington University, St. Louis, Missouri.
FAU - Sacco, Ralph L
AU  - Sacco RL
AD  - The University of Miami, Miami, Florida.
FAU - Lip, Gregory Y H
AU  - Lip GYH
AD  - Liverpool Centre for Cardiovascular Science, University of Liverpool and 
      Liverpool Heart & Chest Hospital, Liverpool, UK.
FAU - Labovitz, Arthur J
AU  - Labovitz AJ
AD  - The University of South Florida, Tampa, Florida.
FAU - Ponikowski, Piotr
AU  - Ponikowski P
AD  - Military Hospital, Wroclaw, Poland.
FAU - Lok, Dirk J
AU  - Lok DJ
AD  - Hospital Deventer, Deventer, the Netherlands.
FAU - Anker, Stefan D
AU  - Anker SD
AD  - Innovative Clinical Trials, Department of Cardiology & Pneumology, University 
      Medical Center Gottingen (UMG), Gottingen, Germany.
FAU - Teerlink, John R
AU  - Teerlink JR
AD  - University of California San Francisco, San Francisco, California.
FAU - Thompson, John L P
AU  - Thompson JLP
AD  - Columbia University Medical Center, New York, New York.
FAU - Homma, Shunichi
AU  - Homma S
AD  - Columbia University Medical Center, New York, New York.
FAU - Freudenberger, Ronald S
AU  - Freudenberger RS
AD  - Department of Cardiology, Lehigh Valley Health Network, Allentown, Pennsylvania.
AD  - The University of South Florida, Tampa, Florida.
CN  - WARCEF Investigators
LA  - eng
PT  - Journal Article
DEP - 20190328
PL  - England
TA  - Eur J Clin Invest
JT  - European journal of clinical investigation
JID - 0245331
SB  - IM
OTO - NOTNLM
OT  - chronic systolic heart failure
OT  - heart failure prognosis
OT  - heart failure with reduced ejection fraction
OT  - pulse pressure
EDAT- 2019/02/26 06:00
MHDA- 2019/02/26 06:01
CRDT- 2019/02/26 06:00
PHST- 2019/01/25 00:00 [revised]
PHST- 2018/10/31 00:00 [received]
PHST- 2019/02/21 00:00 [accepted]
PHST- 2019/02/26 06:00 [pubmed]
PHST- 2019/02/26 06:01 [medline]
PHST- 2019/02/26 06:00 [entrez]
AID - 10.1111/eci.13092 [doi]
PST - ppublish
SO  - Eur J Clin Invest. 2019 Jun;49(6):e13092. doi: 10.1111/eci.13092. Epub 2019 Mar 
      28.