The relationship between pulse pressure and cardiovascular mortality in patients with chronic heart failure

Aim: An increased pulse pressure (PP) has consistently predicted increased cardiovascular morbidity and mortality in patients with cardiovascular risk factors, such as hypertension, diabetes mellitus and mild chronic heart failure (CHF). However, the prognostic value of PP in patients with moderate and severe CHF is less clear. In our study, we investigated the relation between the PP and two-years cardiovascular mortality in patients with mild, moderate and severe CHF.Material and method: Two-hundred and twenty five NYHA class I-IV chronic heart failure patients (188 male, 37 female and mean age: 56.46±12.27 years) were enrolled the study. Physical and echocardiographic examination were performed. Blood pressures were measured at the randomization visit by sphygmomanometer. The patients were followed-up 644±105 days for cardiovascular mortality.Results: We found that pulse pressure was lower in NYHA class IV patients and while the pulse pressure decreases the NYHA class of the patients was increased (p<0.001). All patients were divided in to four groups according to the increased pulse pressure levels (Group I ?35 mmHg, Group II 36?45 mmHg, Group III 46?55 mmHg and Group IV >55 mmHg). Group I patients had a lower left and right ventricular ejection fraction, serum sodium level and Sm velocity, and higher left ventricular dimension, SV E/A and SV Em/Am ratio. Systolic blood pressure and resting heart rate were the most important parameters in predicting left ventricular ejection fraction (p<0.001, beta: 489, p=0.001, beta: -196, respectively). The independent predictors of mortality were pulse pressure, left ventricular ejection fraction, the level of serum sodium and resting heart rate (p< 0.001, p=0.003, p=0.009 and p=0.020, respectively). ROC curve analysis showed that when 40 mmHg was accepted as a cut-off value for pulse pressure in the prediction of mortality, the sensitivity and the specificity were 100% and 63,0%, respectively.Conclusion: In clinical practice, pulse pressure is an easy and reliable metod in predicting mortality and advanced heart failure.Keywords: Heart failure, pulse pressure, mortality