Department of Medicine, University of Kansas School of Medicine, Wichita, Kansas, USA.
The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Heart. 2019 Apr;105(8):639-644. doi: 10.1136/heartjnl-2018-313736. Epub 2018 Oct 25.
Resting pulse pressure (PP) is a risk factor for heart failure (HF); however, whether PP augmentation during exercise, a parameter easily obtained from routine treadmill stress testing, is associated with incident HF is unknown. Thus, we aimed to study the relationship between a novel parameter, the pulse pressure stress index (P2SI), and adverse outcomes among adults undergoing clinical exercise stress testing in the Henry Ford Exercise Testing Project.
The P2SI was calculated as PP at peak exercise divided by resting PP and was analysed continuously and categorically using quartiles. Cox models examined the association between P2SI and adjusted HR (aHR) of incident HF, myocardial infarction (MI) or death. Receiver operating curve (ROC) analyses tested the optimal prognostic cut-point for P2SI.
Among 55 524 participants without prior MI or HF, mean (SD) age was 53 (13) years, 51% were men and 29% black. A total of 2516 HF, 1606 MI and 6224 mortality outcomes occurred. Quartile 3 P2SI (2.0-2.4) was chosen as the reference category based on ROC analyses. There was a graded inverse association of low P2SI with excess HF (aHR of 1.3 (95% CI 1.1 to 1.5) for quartile 2 and 1.5 (95% CI 1.2 to 1.8) for quartile 1, p for trend<0.001) and mortality (aHR of 1.1 (95% CI 1.01 to 1.2) for quartile 2 and 1.3 (95% CI 1.2 to 1.5) for quartile 1, p for trend<0.001). There was no association between P2SI and MI after adjustment. P2SI added significant prognostic information to more established stress testing parameters such as peak systolic blood pressure, per cent maximal predicted heart rate achieved and metabolic equivalents of task achieved.
Poor augmentation of PP with exercise, specifically a P2SI below 2, is a novel and readily quantifiable exercise-based risk feature for HF and death.
静息脉压（PP）是心力衰竭（HF）的一个危险因素；然而，运动时 PP 增加，这是从常规跑步机压力测试中获得的一个参数，它与 HF 的发生是否有关尚不清楚。因此，我们旨在研究一种新的参数，即脉搏压力应激指数（P2SI），与亨利福特运动测试项目中接受临床运动压力测试的成年人不良结局之间的关系。
P2SI 计算为运动峰值时的 PP 除以静息时的 PP，并连续和分类地用四分位数进行分析。Cox 模型检查了 P2SI 与 HF、心肌梗死（MI）或死亡的调整后的 HR（aHR）之间的关系。接收者操作曲线（ROC）分析测试了 P2SI 的最佳预后截断值。
在 55524 名无先前 MI 或 HF 的参与者中，平均（SD）年龄为 53（13）岁，51%为男性，29%为黑人。共发生 2516 例 HF、1606 例 MI 和 6224 例死亡。根据 ROC 分析，选择四分位 3 的 P2SI（2.0-2.4）作为参考类别。低 P2SI 与 HF （四分位 2 的 aHR 为 1.3（95%CI 1.1 至 1.5），四分位 1 的 aHR 为 1.5（95%CI 1.2 至 1.8），趋势检验 p<0.001）和死亡率（四分位 2 的 aHR 为 1.1（95%CI 1.01 至 1.2），四分位 1 的 aHR 为 1.3（95%CI 1.2 至 1.5），趋势检验 p<0.001）之间存在梯度反比关系。在调整后，P2SI 与 MI 之间没有关联。P2SI 为 HF 和死亡提供了比更成熟的压力测试参数更显著的预后信息，如收缩压峰值、最大预测心率百分比和代谢当量。
运动时 PP 增加不良，特别是 P2SI 低于 2，是 HF 和死亡的一种新的、易于量化的基于运动的风险特征。
