Opposite Predictive Value of Pulse Pressure and Aortic Pulse Wave Velocity on Heart Failure With Reduced Left Ventricular Ejection Fraction: Insights From an Eplerenone Post–Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS) Substudy

• Published in: Hypertension (Dallas, Tex. 1979) Vol. 63; no. 1; pp. 105 - 111
• Main Authors: Regnault, Veronique, Lagrange, Jérémy, Pizard, Anne, Safar, Michel E., Fay, Renaud, Pitt, Bertram, Challande, Pascal, Rossignol, Patrick, Zannad, Faiez, Lacolley, Patrick
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD American Heart Association, Inc 01.01.2014; Lippincott Williams & Wilkins; American Heart Association
• Subjects: Acoustics; Aged; Arterial hypertension. Arterial hypotension; Arterial Pressure; Biological and medical sciences; Biomechanics; Blood and lymphatic vessels; Cardiology. Vascular system; Cardiovascular system; Coronary heart disease; Female; Heart; Heart Failure - diagnosis; Heart Failure - etiology; Heart Failure - mortality; Heart Failure - physiopathology; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Humans; Investigative techniques of hemodynamics; Investigative techniques, diagnostic techniques (general aspects); Male; Mechanics; Medical sciences; Middle Aged; Mineralocorticoid Receptor Antagonists - therapeutic use; Myocardial Infarction - complications; Physics; Predictive Value of Tests; Prognosis; Pulse Wave Analysis; Spironolactone - analogs & derivatives; Spironolactone - therapeutic use; Stroke Volume; Ventricular Dysfunction, Left - diagnosis; Ventricular Dysfunction, Left - etiology; Ventricular Dysfunction, Left - mortality; Ventricular Dysfunction, Left - physiopathology; Myocardial infarction; Prognosis; Mineralocorticoid; Cardiovascular disease; Arterial pulse; Aldosterone; Myocardial disease; Knowledge; Reduction; Pulsed pressure; Efficiency; Blood vessel; pulse wave analysis; Predictive value; Aorta; Arterial pressure; Ventricular ejection; Blood pressure; Stiffness; Cardiology; Hypertension; Heart failure; Steroid hormone; Acute; vascular stiffness; Coronary heart disease; Survival; Artery; Left ventricle; Aldosterone antagonist; Eplerenone; Analysis; Adrenal hormone; ventricular ejection fraction; Antihypertensive agent; Hemodynamics; Circulatory system; Ejection fraction; blood pressure; heart failure; hypertension
• ISSN: 0194-911X; 1524-4563; 1524-4563
• DOI: 10.1161/HYPERTENSIONAHA.113.02046

Although hypertension contributes significantly to worsen cardiovascular risk, blood pressure increment in subjects with heart failure is paradoxically associated with lower risk. The objective was to determine whether pulse pressure and pulse wave velocity (PWV) remain prognostic markers, independent of treatment in heart failure with reduced left ventricular function. The investigation involved 6632 patients of the Eplerenone Post–Acute Myocardial Infarction Heart Failure Efficacy and Survival Study. All subjects had acute myocardial infarction with left ventricular ejection fraction <40% and signs/symptoms of heart failure. Carotid-femoral PWV was measured in a subpopulation of 306 subjects. In the overall population, baseline mean arterial pressure <90 mm Hg was associated with higher all-cause death (hazard ratio, 1.14 [95% confidence interval, 1.00–1.30]; P<0.05), whereas higher left ventricular ejection fraction or pulse pressure was associated with lower rates of all-cause death, cardiovascular death/hospitalization, and cardiovascular death. In the subpopulation, increased baseline PWV was associated with worse outcomes (all-cause death1.16 [1.03–1.30]; P<0.05 and cardiovascular deaths1.16 [1.03–1.31]; P<0.05), independent of age and left ventricular ejection fraction. Using multiple regression analysis, systolic blood pressure and age were the main independent factors positively associated with pulse pressure or PWV, both in the entire population or in the PWV substudy. In heart failure and low ejection fraction, our results suggest that pulse pressure, being negatively associated with outcome, is more dependent on left ventricular function and thereby no longer a marker of aortic elasticity. In contrast, increased aortic stiffness, assessed by PWV, contributes significantly to cardiovascular death.