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
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, independe...
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| Published in | Hypertension (Dallas, Tex. 1979) Vol. 63; no. 1; pp. 105 - 111 |
|---|---|
| Main Authors | , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Hagerstown, MD
American Heart Association, Inc
01.01.2014
Lippincott Williams & Wilkins American Heart Association |
| Subjects | |
| Online Access | Get full text |
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| Abstract | 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. |
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| AbstractList | 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 death: 1.16 [1.03-1.30]; P<0.05 and cardiovascular deaths: 1.16 [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.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 death: 1.16 [1.03-1.30]; P<0.05 and cardiovascular deaths: 1.16 [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. 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. 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 death: 1.16 [1.03-1.30]; P<0.05 and cardiovascular deaths: 1.16 [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. 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 death: 1.16 [1.03–1.30]; P <0.05 and cardiovascular deaths: 1.16 [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. |
| Author | Pizard, Anne Lagrange, Jérémy Rossignol, Patrick Lacolley, Patrick Fay, Renaud Challande, Pascal Safar, Michel E. Zannad, Faiez Regnault, Veronique Pitt, Bertram |
| AuthorAffiliation | From INSERM, U1116, Vandoeuvre-les-Nancy, France (V.R., J.L., A.P., P.R., F.Z., P.L.); Université de Lorraine, Nancy, France (V.R., J.L., A.P., P.R., F.Z., P.L.); Centre de Diagnostic, Hôtel-Dieu, Paris, France (M.E.S.); INSERM, Centre d’Investigations Cliniques, Nancy, France (R.F., P.R., F.Z.); University of Michigan, School of Medicine, Ann Arbor, MI (B.P.); UPMC Université Paris 06; CNRS, UMR 7190, Paris, France (P.C.); and CHU Nancy, Pole de Cardiologie, Institut Lorrain du Coeur et des Vaisseaux, Nancy, France (P.R., F.Z., P.L.) |
| AuthorAffiliation_xml | – name: From INSERM, U1116, Vandoeuvre-les-Nancy, France (V.R., J.L., A.P., P.R., F.Z., P.L.); Université de Lorraine, Nancy, France (V.R., J.L., A.P., P.R., F.Z., P.L.); Centre de Diagnostic, Hôtel-Dieu, Paris, France (M.E.S.); INSERM, Centre d’Investigations Cliniques, Nancy, France (R.F., P.R., F.Z.); University of Michigan, School of Medicine, Ann Arbor, MI (B.P.); UPMC Université Paris 06; CNRS, UMR 7190, Paris, France (P.C.); and CHU Nancy, Pole de Cardiologie, Institut Lorrain du Coeur et des Vaisseaux, Nancy, France (P.R., F.Z., P.L.) |
| Author_xml | – sequence: 1 givenname: Veronique surname: Regnault fullname: Regnault, Veronique organization: From INSERM, U1116, Vandoeuvre-les-Nancy, France (V.R., J.L., A.P., P.R., F.Z., P.L.); Université de Lorraine, Nancy, France (V.R., J.L., A.P., P.R., F.Z., P.L.); Centre de Diagnostic, Hôtel-Dieu, Paris, France (M.E.S.); INSERM, Centre d’Investigations Cliniques, Nancy, France (R.F., P.R., F.Z.); University of Michigan, School of Medicine, Ann Arbor, MI (B.P.); UPMC Université Paris 06; CNRS, UMR 7190, Paris, France (P.C.); and CHU Nancy, Pole de Cardiologie, Institut Lorrain du Coeur et des Vaisseaux, Nancy, France (P.R., F.Z., P.L.) – sequence: 2 givenname: Jérémy surname: Lagrange fullname: Lagrange, Jérémy – sequence: 3 givenname: Anne surname: Pizard fullname: Pizard, Anne – sequence: 4 givenname: Michel surname: Safar middlename: E. fullname: Safar, Michel E. – sequence: 5 givenname: Renaud surname: Fay fullname: Fay, Renaud – sequence: 6 givenname: Bertram surname: Pitt fullname: Pitt, Bertram – sequence: 7 givenname: Pascal surname: Challande fullname: Challande, Pascal – sequence: 8 givenname: Patrick surname: Rossignol fullname: Rossignol, Patrick – sequence: 9 givenname: Faiez surname: Zannad fullname: Zannad, Faiez – sequence: 10 givenname: Patrick surname: Lacolley fullname: Lacolley, Patrick |
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| Keywords | 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 |
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| References_xml | – ident: e_1_3_4_5_2 doi: 10.1161/01.HYP.32.3.556 – ident: e_1_3_4_14_2 doi: 10.1161/hypertensionaha.107.109314 – ident: e_1_3_4_29_2 doi: 10.1161/01.cir.0000164273.57823.26 – ident: e_1_3_4_2_2 doi: 10.1161/hypertensionaha.109.134379 – ident: e_1_3_4_22_2 doi: 10.1161/01.CIR.96.12.4254 – ident: e_1_3_4_9_2 doi: 10.1161/circheartfailure.109.869743 – ident: e_1_3_4_20_2 doi: 10.1161/01.ATV.0000160548.78317.29 – ident: e_1_3_4_32_2 doi: 10.1016/j.echo.2013.03.022 – volume: 5 start-page: 892 year: 2004 ident: e_1_3_4_27_2 article-title: A low pulse pressure is an independent predictor of mortality in heart failure: data from a large nationwide cardiology database (IN-CHF Registry). publication-title: Ital Heart J – ident: e_1_3_4_8_2 doi: 10.1093/eurheartj/ehr254 – ident: e_1_3_4_34_2 doi: 10.1097/HJH.0b013e32833c2088 – ident: e_1_3_4_15_2 doi: 10.1056/NEJMoa030207 – ident: e_1_3_4_11_2 doi: 10.1038/sj.jhh.1001965 – ident: e_1_3_4_10_2 doi: 10.1136/hrt.2007.134973 – ident: e_1_3_4_18_2 doi: 10.1161/01.hyp.0000164580.39991.3d – ident: e_1_3_4_3_2 doi: 10.1152/japplphysiol.90549.2008 – ident: e_1_3_4_6_2 doi: 10.1161/hypertensionaha.107.095513 – ident: e_1_3_4_16_2 doi: 10.1056/NEJMoa1009492 – ident: e_1_3_4_21_2 doi: 10.1016/S0735-1097(98)00679-2 – ident: e_1_3_4_24_2 doi: 10.1016/j.amjcard.2003.12.011 – ident: e_1_3_4_13_2 doi: 10.1016/j.amjcard.2009.01.347 – ident: e_1_3_4_19_2 doi: 10.1093/eurheartj/ehl254 – ident: e_1_3_4_23_2 doi: 10.1007/s00392-011-0360-x – ident: e_1_3_4_26_2 doi: 10.1253/circj.CJ-08-0323 – ident: e_1_3_4_12_2 doi: 10.1038/ajh.2008.277 – ident: e_1_3_4_25_2 doi: 10.1016/j.ijcard.2011.02.025 – ident: e_1_3_4_30_2 doi: 10.1016/j.cardfail.2009.03.006 – ident: e_1_3_4_33_2 doi: 10.1253/circj.CJ-08-0350 – ident: e_1_3_4_31_2 doi: 10.1161/hypertensionaha.111.00163 – ident: e_1_3_4_4_2 doi: 10.1152/ajpheart.00063.2007 – ident: e_1_3_4_7_2 doi: 10.1038/nrcardio.2010.165 – ident: e_1_3_4_17_2 doi: 10.1038/jhh.2008.42 – ident: e_1_3_4_28_2 doi: 10.1093/eurheartj/ehi270 |
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| Snippet | Although hypertension contributes significantly to worsen cardiovascular risk, blood pressure increment in subjects with heart failure is paradoxically... |
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| SubjectTerms | 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 |
| Title | 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 |
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