Introduction: Proportional pulse pressure (PPP) is known as a simple index correlated with cardiac index (CI) especially in heart failure patients with reduced left ventricular function. Although PPP could alter after several intervention for heart failure, the impact of PPP changes on prognosis had not fully been evaluated.
Hypothesis: We hypothesized decreased PPP could be associated with the worse outcomes in hospitalized HFrEF patients.
Methods: We retrospectively analyzed using database of the West Tokyo Heart Failure (WET-HF) Registry. We only included acute heart failure patients with ejection fraction was lower than 40%. We defined decreased PPP as decrease of PPP greater than 10% from hospitalization to discharge. Clinical outcomes were compared between patients with and without decreased PPP.
Results: Total 692 patients (mean age, 71.9 years; 69% male) were analyzed. Decreased PPP developed in 72 patients (10%). During the follow-up period of 664±535days, 168 (24%) patients had all-cause mortality, 75 patients (11%) had cardiovascular mortality, 219 (33%) patients were rehospitalized with HF. Kaplan-Meier curves and the log-rank test demonstrated the patients with decreased PPP had significantly higher incidence of all-cause mortality (p=0.03), cardiovascular mortality (p=0.007) and HF rehospitalization (P=0.002). A multivariate Cox regression analysis revealed decreased PPP was independently associated with higher risk of all-cause mortality (HR 1.78, 95% CI 1.10-2.76), cardiovascular mortality (HR 2.50, 95% CI 1.31-4.45) and HF rehospitalization (HR 1.63, 95% CI 1.06-2.43) after adjusting for other risk factors, including variables of American Heart Association Get With the Guidelines-Heart Failure (GWTG-HF) risk score.
Conclusion: Decreased PPP is an independent predictor of adverse outcomes in HFrEF patients.