BHF Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK
Division of Cardiology, Città della Salute e della Scienza Hospital, Department of Medical Sciences, University of Turin, Torino, Italy.
Eur Heart J. 2015 May 7;36(18):1106-14. doi: 10.1093/eurheartj/ehu490. Epub 2015 Jan 23.
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.
脉压降低是心力衰竭（HF）伴射血分数降低（HF-REF）患者不良预后的标志物，但脉压在射血分数保留的心力衰竭（HF-PEF）患者中的预后价值尚不清楚。我们研究了脉压在 HF-PEF [射血分数（EF）≥50%]和 HF-REF 患者中的预后价值。
研究分析了 22 项 HF 研究的数据。保留的左心室射血分数（LVEF）定义为 LVEF≥50%。在 27046 例患者中评估了 3 年全因死亡率：22038 例 HF-REF（4980 例死亡）和 5008 例 HF-PEF（828 例死亡）。在多变量模型中，根据先前报道的 Meta-Analysis Global Group in Chronic Heart Failure 预后变量对脉压进行五分位分析。与其他所有脉压组相比，脉压最低五分位的心力衰竭和射血分数降低患者的死亡率风险最高（调整后的危险比 1.68，95%置信区间 1.53-1.84）。对于 HF-PEF 患者，较高的脉压与较高的死亡率相关，在调整其他预后变量后，这种相关性消失。
在 HF-REF 患者中，较低的脉压（尤其是<53mmHg）是死亡率的独立预测因子，尤其是在 LVEF<30%和收缩压<140mmHg 的患者中。总体而言，HF-PEF 患者的脉压与预后之间的这种关系并不一致。
