Relation between pulse pressure and survival in patients with decompensated heart failure

Interaction between pulse wave velocity, augmentation index, pulse pressure and left ventricular function in chronic heart failure

“…15 Moreover, increased EF and CF-PWV influenced the prognosis of cardiovascular disease in opposite directions, which could partly explain some apparent contradictions in the literature [6][7][8][9] in the use of PP as a prognostic factor. Moreover, while relationships between PP and EF or ED were constant whatever the EF level, CF-PWV seemed to have more influence on PP in patients with preserved systolic function than in patients with systolic dysfunction, on the basis of the Wald coefficients (2.871.0 versus 6.571.1).…”

“…Recently however, in two large studies of relatively unselected subjects, including a large proportion of patients with decompensated heart failure (irrespective of the ejection fraction (EF)), an inverse relationship was found between PP and all-cause mortality. 8,9 As PP is influenced not only by arterial stiffness but also by cardiac factors such as heart rate (HR) and stroke volume, pulse wave velocity (PWV), a direct marker of aortic stiffness, or the carotid augmentation index (AIx), a marker of aortic stiffness and wave reflection, might have better prognostic value than PP. PWV is independently associated with cardiovascular morbidity and mortality in patients with hypertension or diabetes, and in the elderly, [10][11][12] whereas AIx is associated with cardiovascular risk factors (CVR) in the general population 13 and with mortality in patients with end-stage renal failure.…”

Is the predictive power of a low-pulse pressure independent of peak oxygen uptake in advanced chronic heart failure?

“…In the population at large and in patients with hypertension without clinical evidence of LV dysfunction, PP mainly reflects vascular stiffness, which explains the association of a high PP with a worse prognosis. [1][2][3][4] By contrast, recent studies have shown that a low PP carries a worse prognosis in patients with advanced chronic heart failure (CHF) 5,6 and decompensated heart failure, 7 which is attributed to the fact that the impaired LV function has become the major determinant of PP. However, peak oxygen uptake (VO 2 peak), which is a major if not the major prognostic factor in CHF 8,9 was not considered in these studies.…”

“…First, when the current and previous studies are considered together it appears that the impaired prognosis is mainly associated with PP o35-40 mm Hg and that outcome is rather similar in subgroups with PP above that level. [5][6][7] Second, a low PP is associated with a worse outcome in patients with CHF, whereas the inverse is true in other patient populations, that is hypertensive patients, 1,3,4 survivors of myocardial infarction 10 and even patients with LV dysfunction or mild heart failure. 11 This can be explained by the fact that PP results from vascular stiffening and ejection rate or stroke volume.…”

Prognostic Significance of Right Ventricular Dimension on Acute Decompensation in Chronic Left-Sided Heart Failure

“…52) Shinagawa, et al 53) found that the serum T-Bil levels at the time of HF decompensation more exactly reflect the hemodynamics, especially cardiac index, compared with when HF is more controlled. In our study, RVDd and serum T-Bil levels at the time of HF exacerbation were regarded as markers of the hemodynamic response to deteriorated HF, which reflected the cardiac pump/circulatory reserve, leading to differentiation of HF prognosis even among patients with similar HF status during the stable phase.…”