4.5 U-SHAPED RELATIONSHIP OF RESERVOIR PRESSURE TO CARDIOVASCULAR EVENTS IN PATIENTS WITH HEART FAILURE WITH REDUCED EJECTION FRACTION

DOI

10.1016/j.artres.2016.10.024How to use a DOI?

Abstract

Objectives: Parameters of aortic stiffness are considered important indicators of cardiovascular risk. However, in heart failure with reduced ejection fraction (HFrEF), their association to outcome was found to be inversed. The aim of this work was to analyze the relationship of the amplitude of reservoir pressure (PresAmp) to cardiovascular events in HFrEF.

Methods: Patients with HFrEF were collected from a cohort undergoing coronary angiography at the hospital Wels-Grieskirchen, Austria. PresAmp was computed from central pressure obtained from radial readings by a generalized transfer function. A combination of myocardial infarction, death, stroke and cardiovascular revascularization served as primary endpoint. Cox-regression analysis and Kaplan-Meier estimates were used for survival analysis.

Results: 83 (9 female) patients were included with a mean age of 61 years. During a median follow-up of 1272 days, 30 patients suffered from the combined endpoint. No significant linear association to outcome was found for PresAmp, brachial or central pulse pressure in Cox-analysis. In all three cases, Kaplan-Meier analysis comparing the respective quartiles indicated a nonlinear, U-shaped relation, but only for PresAmp the increase in risk was significant (P<0.05) in both directions. Although patients with low (16.6 (2.8 SD) mmHg) and high (26.1 (3.2 SD) mmHg) PresAmp showed similar risk, they differed in blood pressure, age, presence of hypertension, presence of coronary artery disease, ventricular dimensions, ejection fraction and diastolic function (table).

Conclusion: We found a U-shaped relation of reservoir pressure to outcome in our population. Pulsatile hemodynamics seem to separate patients with HFrEF into different phenotypes with different prognosis.

Parameter	1st quartile PresAmp	4th quartile PresAmp	P-value
N patients	21 (19m/2f)	21 (19m/2f)
Age, years	57.1 (9.68 SD)	69.4 (9.24 SD)	<0.001
Hypertension	6 (29 %)	19 (90 %)	<0.001
Coronary artery disease	8 (38 %)	14 (67 %)	0.06
Brachial PP, mmHg	31.0 (6.87 SD)	63.0 (8.32 SD)	<0.001
Central PP, mmHg	20.4 (4.08 SD)	48.6 (9.33 SD)	<0.001
E/E’medial	30.8 (15.8 SD)	19.3 (10.0 SD)	0.008
EF, %	22.5 (7.33 SD)	31.6 (7.49 SD)	<0.001
LVEDV, ml	253 (91.3 SD)	162 (64.5 SD)	<0.001
LVESV, ml	199 (75.8 SD)	112 (50.8 SD)	<0.001

Table:

Comparison of patients with low (1^st quartile) and high (4^th quartile) PresAmp. PP, pulse pressure. EF, ejection fraction. LVEDV, left ventricular end-diastolic volume. LVESV, left ventricular end-systolic volume. Values are presented as mean (standard deviation).

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TY  - JOUR
AU  - Stephanie Parragh
AU  - Bernhard Hametner
AU  - Christopher Mayer
AU  - Siegfried Wassertheurer
AU  - Thomas Weber
PY  - 2016
DA  - 2016/11/24
TI  - 4.5 U-SHAPED RELATIONSHIP OF RESERVOIR PRESSURE TO CARDIOVASCULAR EVENTS IN PATIENTS WITH HEART FAILURE WITH REDUCED EJECTION FRACTION
JO  - Artery Research
SP  - 55
EP  - 55
VL  - 16
IS  - C
SN  - 1876-4401
UR  - https://doi.org/10.1016/j.artres.2016.10.024
DO  - 10.1016/j.artres.2016.10.024
ID  - Parragh2016
ER  -