Pulse pressure as a haemodynamic variable in systolic heart failure
Pulse pressure represents systolic minus diastolic blood pressure (PP=SBP-DBP). Elevated PP predicts mortality in heart failure with reduced ejection fraction (HF-REF) and mild symptoms. With increasing symptoms, there is a reversal of the usual relationship between PP and outcome. We demonstrated that lower pulse pressure independently predicted mortality in very symptomatic HF-REF patients (n= 1901).
In patients with low ejection fraction (EF) following a heart attack (n= 1955), a low pulse pressure independently predicted death but only in patients with clinical signs of heart failure. In 1897 patients with complete right and left heart catheterization data, PP was related to cardiac index (CI). The relationship was non-linear and less evident as both variables increased. In a multivariable model including all measured haemodynamics, PP and proportional PP {PPP= PP/SBP} predicted cardiac index. Only when CI was low, was PP low.
In a hospitalized acute heart failure cohort (n= 63, but included 171 pairs of measurements taken within 3 minutes of each other) all with elevated pulmonary capillary wedge pressure, low EF and requiring intravenous diuretic, brachial PPP correlated significantly with CI. This was at baseline and after standard treatments including serelaxin. PPP was the strongest (non-invasive) parameter to predict CI.
In conclusion, a low pulse pressure is a simple marker predicting adverse outcome in symptomatic heart failure with reduced ejection fraction.