ESC Heart Failure (Aug 2021)

Distinctive prognostic factor of heart failure with preserved ejection fraction stratified with admission blood pressure

  • Akito Nakagawa,
  • Yoshio Yasumura,
  • Chikako Yoshida,
  • Takahiro Okumura,
  • Jun Tateishi,
  • Junichi Yoshida,
  • Shunsuke Tamaki,
  • Masamichi Yano,
  • Takaharu Hayashi,
  • Yusuke Nakagawa,
  • Takahisa Yamada,
  • Daisaku Nakatani,
  • Shungo Hikoso,
  • Yasushi Sakata,
  • Osaka CardioVascular Conference (OCVC)‐Heart Failure investigators

DOI
https://doi.org/10.1002/ehf2.13420
Journal volume & issue
Vol. 8, no. 4
pp. 3145 – 3155

Abstract

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Abstract Aims The prognostic importance of admission systolic blood pressure (SBP) in heart failure with preserved ejection fraction (HFpEF) is elusive. We aimed to clarify the pathophysiological differences between patients categorized with admission SBP among HFpEF patients. Methods and results We studied 1008 inpatients from PURSUIT‐HFpEF, a multicentre prospective observational registry. We classified patients as having elevated (>140 mmHg), preserved (90–140 mmHg), or low (<90 mmHg) admission SBP. Most cases had elevated (n = 584) or preserved (n = 420) SBP; the four cases with low SBP were excluded. Univariable Cox regression testing revealed that preserved SBP patients had a higher risk of a composite of cardiac death and heart failure re‐hospitalization [hazard ratio (HR) 1.48, 95% confidence interval (CI) 1.14–1.92, P = 0.0035] than elevated SBP patients. In multivariable Cox regression models, while prior heart failure hospitalization (HR 1.36, 95% CI 1.01–2.84, P = 0.0453), atrial fibrillation (HR 1.82, 95% CI 1.10–2.99, P = 0.0209), and N‐terminal pro‐B‐type natriuretic peptide (HR 1.94, 95% CI 1.10–3.43, P = 0.0229) at discharge were significantly associated with adverse outcomes in elevated SBP patients, N‐terminal pro‐B‐type natriuretic peptide (HR 2.06, 95% CI 1.04–4.07, P = 0.0373) and right ventricular‐pulmonary artery uncoupling reflected by the tricuspid annular plane systolic excursion/pulmonary artery systolic pressure ratio (HR 0.19, 95% CI 0.05–0.65, P = 0.0075) at discharge were significant prognostic factors in preserved SBP patients. Conclusions Patients with preserved admission SBP had significant higher risks for adverse outcomes than those with elevated SBP in HFpEF. Tricuspid annular plane systolic excursion/pulmonary artery systolic pressure was the distinctive prognostic factor between the two groups.

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