Background: Pulse Pressure (PP), Augmentation Index (AIx), and Pulse Wave Velocity (PWV) are directly and positively associated with cardiovascular risk. However, in heart failure patients, an association between a lower PP and a worse outcome has been reported as well.

Methods: We measured AIx, using applanation tonometry (SphygmoCor) in 53 patients with severe cardiomyopathy (CMP) and 106 controls matched for age, gender, and diastolic blood pressure. All patients underwent coronary angiography for suspected coronary heart disease. In a subgroup (14 patients, 28 controls), we assessed PWV during catheter pullback.

Results: Mean age was 63.3 vs 63.6 years, ejection fraction (EF) was 28 vs 68% in patients vs controls, respectively. Central (but not peripheral) PP (32 vs 37 mmHg, p = 0.01) and AIx (16 vs 23, p = 0.001) were lower, ejection duration was shorter (260 vs 308 msec, p < 0.00001) in patients, as compared to controls. When we subdivided the CMP patients with respect to AIx, those below the median had more advanced systolic dysfunction. In multiple regression analysis, EF was an independent predictor of AIx. PVW did not differ between patients and controls (7.8 m/s each group, p = 0.99).

Conclusions: For the same level of DBP, cardiomyopathy patients show significantly lower central PP and AIx, but no difference in PWV, as compared to controls. Therefore, a low EF, an important prognostic determinant, is not (PWV) or even inversely (central PP, AIx) represented by these measures of arterial function. When they are used for risk stratification, knowledge of systolic function is required as well.