Differing prognostic value of pulse pressure in patients with heart failure with reduced or preserved ejection fraction: results from the MAGGIC individual patient meta-analysis
Differing prognostic value of pulse pressure in patients with heart failure with reduced or preserved ejection fraction: results from the MAGGIC individual patient meta-analysis
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DOI：
10.1093/eurheartj/ehu490
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发表时间：
2015-05-07
影响因子：
39.3
通讯作者：
McMurray, John J. V.
中科院分区：
文献类型：
--
作者：
Jackson, Colette E.;Castagno, Davide;McMurray, John J. V.
低脉压是心力衰竭（HF）和射血分数降低（HF-REF）患者不良结局的标志，但脉压在HF和射血分数保留（HF-PEF）患者中的预后价值尚不清楚。我们研究了HF-PEF [射血分数（EF）>= 50%]和HF-REF.Methods和结果的患者的脉压的预后价值从22 HF研究进行了检查。左心室射血分数（LVEF）维持定义为LVEF >= 50%。在27046例患者中评价了3年全因死亡率：22038例HF-REF（4980例死亡）和5008例HF-PEF（828例死亡）。在一个多变量模型中，以五分位数对脉压进行分析，该模型针对先前报告的慢性心力衰竭预后变量荟萃分析全球组进行了调整。与所有其他脉压组相比，最低脉压五分位数的心力衰竭和射血分数降低患者的粗死亡率和校正死亡率风险最高（校正风险比1.68，95%置信区间1.53-1.84）。对于HF-PEF患者，较高的脉压与最高的粗死亡率相关，在调整其他预后变量后，该梯度被消除。
Aims 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.Methods and results 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.Conclusion Lower pulse pressure (especially