Prognostic value of pulse pressure after an acute coronary syndrome

Pulse pressure and all-cause mortality in ischaemic heart failure patients: a prospective cohort study

BACKGROUND

Whether the association between pulse pressure (PP) and mortality varies with systolic blood pressure (SBP) in ischaemic heart failure (HF) with left ventricular systolic dysfunction (LVSD) is unknown.

OBJECTIVE

To evaluate the association between PP and all-cause mortality in ischaemic HF patients with SBP status at admission.

PATIENTS AND METHODS

This prospective cohort study included 1581 ischaemic HF patients with LVSD. A total of 23.3% (n = 368) and 22.2% (n = 351) of the participants had SBP <110 mmHg and SBP >140 mmHg, respectively, with more than 80% of participants being male. Restricted cubic spline was performed to determine whether a nonlinear relationship existed between PP and all-cause mortality risk. A multivariable Cox proportional hazards model was used to assess the association between PP and all-cause mortality.

RESULTS

After a median of follow-up of 3.0 years, 257 events (16.4%) were observed in the cohort. There was a J-shaped relationship between PP and all-cause mortality (P value for nonlinearity = 0.020), with a risk nadir of approximately 46-49 mmHg. All-cause mortality risk varied with SBP status. Higher PP was associated with worse prognosis when the SBP was ≥110 mmHg, whereas the relationship did not reach statistical significance when the SBP was <110 mmHg.

CONCLUSION

A J-shaped relationship between PP and all-cause mortality was observed in ischaemic HF patients with LVSD, and higher PP was associated with worse prognosis only in those with SBP ≥110 mmHg. Further studies are needed to corroborate these findings.KEY MESSAGESA J-shaped relationship between pulse pressure and all-cause mortality was observed in ischaemic heart failure patients with left ventricular systolic dysfunction, with a risk nadir of approximately 46-49 mmHg.All-cause mortality risk varied with systolic blood pressure status, and higher pulse pressure was associated with worse prognosis when systolic blood pressure was above 110 mmHg.

Association Between Pulse Pressure With All-Cause and Cardiac Mortality in Acute Coronary Syndrome: An Observational Cohort Study

Background

Pulse pressure (PP) is a surrogate of aortic stiffness, and reflects cardiac performance and stroke volume. Previous studies have indicated that PP was a robust predictor of cardiovascular outcomes and mortality. However, results have been mixed, and very few studies have focused on the association of PP with mortality in acute coronary syndrome (ACS). Thus, we aimed to investigate the relationship between admission PP and the prognosis of patients with ACS.

Methods

This cohort study included 10,824 patients diagnosed with ACS from the Cardiovascular Center Beijing Friendship Hospital Database Bank (CBDBANK) from January 2013 to October 2018. Patients with cardiogenic shock, malignancy, severe trauma and, no PP at admission were excluded. Restricted cubic spline and Cox proportional hazards regression were used to evaluate the association between PP and 1-year all-cause and cardiac mortality.

Results

In the whole cohort, a total of 237 (2.19%) all-cause deaths were reported at 1-year follow-up. Restricted cubic spline analysis suggested a J-shaped relationship between PP and mortality. Among patients with ACS, both lower and higher PP levels were related to an increased risk of mortality (Pnon–linear &lt; 0.001); with a PP level of 30 or 80 mmHg, as compared with 50 mmHg, the adjusted hazard ratios for 1-year all-cause mortality were 2.02 (95% CI, 1.27–3.22) and 1.62 (95% CI, 1.13–2.33), respectively, after adjustments for potential confounders. Similar results were observed for cardiac deaths. The J-shaped relationship between PP and mortality remained in a series of subgroup analyses.

Conclusion

Our results suggested that both low and high PP were associated with an increased risk of mortality in patients with ACS.

Association Between Admission Pulse Pressure and Long-Term Mortality in Elderly Patients With Type 2 Diabetes Mellitus Admitted for Acute Coronary Syndrome: An Observational Cohort Study

Objective

The aim of this study was to assess the effect of pulse pressure (PP) at admission on long-term cardiac and all-cause mortality among elderly patients with type 2 diabetes mellitus (T2DM) admitted for acute coronary syndrome (ACS).

Methods

This is a retrospective observational study. The patients aged at least 65 years with T2DM and ACS from January 2013 to April 2018 were enrolled and divided into 4 groups according to admission PP: <50 mmHg; 50–59 mmHg; 60–69 mmHg, and ≥70 mmHg. Multivariate Cox proportional hazard regression analyses and restricted cubic spline were performed to determine the association between PP and outcomes (cardiac and all-cause death).

Results

A total of 2,587 consecutive patients were included in this cohort study. The mean follow-up time was 39.2 months. The incidences of cardiac death and all-cause death were 6.8% (n = 176) and 10.8% (n = 280), respectively. After multivariate adjustment in the whole cohort, cardiac and all-cause mortality were significantly higher in PP <50 mmHg group and PP ≥70 mmHg group, compared with PP 50–59 mmHg group. Further analysis in acute myocardial infarction (AMI) subgroup confirmed that PP <50 mmHg was associated with cardiac death [hazard ratios (HR) 2.92, 95% confidence interval (CI) 1.45–5.76, P = 0.002] and all-cause death (HR 2.08, 95% CI 1.20–3.58, P = 0.009). Meanwhile, PP ≥70 mmHg was associated with all-cause death (HR 1.78, 95% CI 1.05–3.00, P = 0.031). However, admission PP did not appear to be a significant independent predictor in unstable angina pectoris (UAP) subgroup. There is a U-shaped correlation between PP and cardiac and all-cause mortality in the whole cohort and UAP subgroup and a J-shaped correlation in the AMI subgroup, both with a nadir at 50–59 mmHg.

Conclusion

In elderly patients with T2DM admitted for ACS, admission PP is an independent and strong predictor for long-term cardiac and all-cause mortality, especially in patients with AMI.

Effects of enriched seafood sticks (heat-inactivated B. animalis subsp. lactis CECT 8145, inulin, omega-3) on cardiometabolic risk factors and gut microbiota in abdominally obese subjects: randomized controlled trial

PURPOSE

To assess the effects of enriched seafood sticks with postbiotic and bioactive compounds on CMD risk factors and the gut microbiota in abdominally obese individuals.

METHODS

Randomized, double-blind, parallel, placebo-controlled trial with abdominally obese individuals. Participants (n = 120) consumed 50 g/day of enriched seafood sticks containing SIAP: (10¹⁰ colony forming units (CFUs) of heat-inactivated B. animalis subsp. lactis CECT8145, 370 mg/day omega 3 and 1.7 g/day inulin), or 50 g/day of placebo seafood sticks for 12 weeks. At 12 weeks, an acute single-dose study of 4 h was performed.

RESULTS

Sustained SIAP2 consumption significantly decreased the insulin by - 5.25 mg/dL and HOMA-IR (homeostatic Model Assessment of Insulin Resistance) by - 1.33. In women, SIAP2 consumption significantly decreased the pulse pressure (PP) by - 4.69 mmHg. Gut microbiota analysis showed a negative association between glycemic parameter reduction and Alistipes finegoldii and Ruminococcaceae, and between PP reduction and Prevotella 9-ASV0283 and Christensenellaceae. In the acute single dose-study 4-h, SIAP2 consumption produced a lower increase in the postprandial circulating triglyceride levels [23.9 (7.03) mg/dL (mean [standard error])] than the observed with placebo [49.0 (9.52)] mg/dL.

CONCLUSION

In abdominally obese individuals, enriched seafood sticks induce a potential protection against type 2 diabetes development by the reduction in the insulin and HOMA-IR; and in cardiovascular disease, in women, by the PP reduction. These effects are accompanied by partial changes in the gut microbiota composition. The enriched seafood sticks reduce the atherogenic triglyceride postprandial concentrations. Our results support the use of enriched seafood sticks as a complementary strategy in the management of CMD risk factors. REGISTRATION NUMBER OF CLINICAL TRIAL: ( www.

CLINICALTRIALS

gov ): NCT03630588 (August 15, 2018).

The U-shape relationship between pulse pressure level on inpatient admission and long-term mortality in acute coronary syndrome patients undergoing percutaneous coronary intervention

The association between pulse pressure and long-term mortality was investigated among acute coronary syndrome (ACS) patients who received percutaneous coronary intervention (PCI). The study population included 5055 ACS patients in the Department of Cardiology of Beijing Friendship Hospital who were enrolled from January 2013 to July 2019. The median duration of follow-up was 24 months. Multivariate Cox regression was used to analyze the relationships between PP on inpatient admission and mortalities. Non-linear associations were studied by restricted cubic splines. Considering the heart function, the analyses were performed in the whole cohort and the LVEF > = 0.5 cohort separately. Subgroup analyses were performed according to the different diagnosis (the myocardial infarction subgroup and the unstable angina pectoris subgroup). When PP was used as categorical variable, the high PP group (≥61 mm Hg) significantly increased the risk of death compared with the intermediate PP group (50-60 mm Hg) in the both cohorts. When PP was used as continuous variable, a U-shape relationship were found between PP and mortalities in the whole cohort (p (for nonlinearity) = .005 and .003, respectively), with reference PP level of 55 mm Hg. However, this U-shape relationship disappeared in the LVEF > 0.5 cohort (p (for nonlinearity) = .111 and .117, respectively). The similar results were obtained in MI subgroup. From this study, the U-shape relationships between PP level and all-cause and cardiac mortalities were found in ACS patients who underwent PCI. The U-shape relationships disappeared in the LVEF > 0.5 cohort. The reference PP level was 55 mm Hg.

Association between polyvascular disease and clinical outcomes in patients with cardiogenic shock: Results from the RESCUE registry

BACKGROUND

Clinical implications of systemic atherosclerosis in patients with cardiogenic shock (CS) remain unclear. This study investigated the association between polyvascular disease (PVD) and clinical outcome in CS patients.

METHODS

A total of 1247 CS patients was enrolled from the RESCUE registry, a multicenter, observational cohort between January 2014 and December 2018. They were divided into two groups according to presence of PVD, defined as ≥2 coexistence of coronary artery disease, peripheral arterial disease, or cerebrovascular disease. Primary outcome was all-cause death during 12 months of follow-up.

RESULTS

136 (10.9%) patients were diagnosed with PVD. The risk of 12-month all-cause death was significantly higher in the PVD group than in the non-PVD group (54.4% versus 40.4%, adjusted hazard ratio [HR] 1.31, 95% confidence interval [CI] 1.02-1.69, p = 0.034). There was a significant interaction between PVD and vasoactive inotropic score (VIS) (p for interaction = 0.014). Among the 945 patients with VIS <84, PVD was associated with a higher risk of 12-month all-cause death (unadjusted HR 1.77, 95% CI 1.30-2.41, p = 0.030); among the 302 patients with VIS ≥84, the incidence of 12-month all-cause death was similar between the PVD and non-PVD groups (unadjusted HR 1.03, 95% CI 0.68-1.56, p = 0.301).

CONCLUSIONS

Presence of PVD was associated with 12-month all-cause mortality in patients with CS, especially for less severe forms of CS patients with VIS <84. Clinicaltrials.govnumber:NCT02985008.

Pulse pressure during the initial resuscitative period in patients with septic shock treated with a protocol-driven resuscitation bundle therapy

BACKGROUND/AIMS

Maintaining a mean arterial pressure (MAP) ≥ 65 mmHg during septic shock should be based on individual circumstances, but specific target is poorly understood. We investigated associations between time-weighted average (TWA) hemodynamic parameters during the initial resuscitative period and 28-day mortality.

METHODS

Prospectively collected data were obtained from a septic shock patient registry, according to the Sepsis-3 definition, between 2016 and 2018. The TWA systolic blood pressure, diastolic blood pressure, MAP, shock index, and pulse pressure (PP) during the first 6 hours after shock recognition were compared. Multivariable regression analysis was performed to assess associations between these parameters and 28-day mortality.

RESULTS

Of 340 patients with septic shock, 92 died. Only the median TWA PP differed between the survivors and non-survivors (39.2 mmHg vs. 43.0 mmHg, p = 0.020), whereas the other indexes did not. When PP was divided into quartiles (< 34, 34 to 40, 40 to 48, and > 48 mmHg), the mortality rate was higher in the highest quartile (41.2%). Multivariable logistic analysis revealed that PP (odds ratio [OR], 1.28; 95% confidence interval [CI], 1.012 to 1.622; p = 0.039) and PP of > 48 mmHg (OR, 2.25; 95% CI, 1.272 to 3.981; p = 0.005) were independently associated with 28-day mortality.

CONCLUSION

PP was significantly associated with 28-day mortality in patients with septic shock and MAP maintained at > 65 mmHg during the first 6 hours. Further studies are warranted to optimize strategies for maintaining PP and MAP at > 65 mmHg during the early resuscitative period.

Impact of pulse pressure on clinical outcome in extracorporeal cardiopulmonary resuscitation (eCPR) patients

BACKGROUND

Hemodynamic response to successful extracorporeal cardiopulmonary resuscitation (eCPR) is not uniform. Pulse pressure (PP) as a correlate for myocardial damage or recovery from it, might be a valuable tool to estimate the outcome of these patients.

METHODS

We report retrospective data of a single-centre registry of eCPR patients, treated at the Interdisciplinary Medical Intensive Care Unit at the Medical Centre, University of Freiburg, Germany, between 01/2017 and 01/2020. The association between PP of the first 10 days after eCPR and hospital survival was investigated. Moreover, patients were divided into three groups according to their PP [low (0-9 mmHg), mid (10-29 mmHg) and high (≥ 30 mmHg)] at each time point.

RESULTS

One hundred forty-three patients (age 63 years, 74.1% male, 40% OHCA, average low flow time 49 min) were analysed. Overall hospital survival rate was 28%. A low PP both early after eCPR (after 1, 3, 6 and 12 h) and after day 1 to day 8 was associated with reduced hospital survival. At each time point (1 h to day 5) the classification of patients into a low, mid and high PP group was able to categorize the patients for a low (5-20%), moderate (20-40%) and high (50-70%) survival rate. A multivariable analysis showed that the mean PP of the first 24 h was an independent predictor for survival (p = 0.008).

CONCLUSION

In this analysis, PP occurred to be a valuable parameter to estimate survival and maybe support clinical decision making in the further course of patients after eCPR.

Effects of hesperidin in orange juice on blood and pulse pressures in mildly hypertensive individuals: a randomized controlled trial (Citrus study)

Purpose

To assess the sustained and acute effects, as well as the influence of sustained consumption on the acute effects, of orange juice (OJ) with a natural hesperidin content and hesperidin-enriched OJ (EOJ) on blood (BP) and pulse (PP) pressures in pre- and stage-1 hypertensive individuals.

Methods

In a randomized, parallel, double-blind, placebo-controlled trial, participants (n = 159) received 500 mL/day of control drink, OJ, or EOJ for 12 weeks. Two dose–response studies were performed at baseline and after 12 weeks.

Results

A single EOJ dose (500 mL) reduced systolic BP (SBP) and PP, with greater changes after sustained treatment where a decrease in diastolic BP (DBP) also occurred (P < 0.05). SBP and PP decreased in a dose-dependent manner relative to the hesperidin content of the beverages throughout the 12 weeks (P < 0.05). OJ and EOJ decreased homocysteine levels at 12 weeks versus the control drink (P < 0.05). After 12 weeks of EOJ consumption, four genes related to hypertension (PTX3, NLRP3, NPSR1 and NAMPT) were differentially expressed in peripheral blood mononuclear cells (P < 0.05).

Conclusion

Hesperidin in OJ reduces SBP and PP after sustained consumption, and after a single dose, the chronic consumption of EOJ enhances its postprandial effect. Decreases in systemic and transcriptomic biomarkers were concomitant with BP and PP changes. EOJ could be a useful co-adjuvant tool for BP and PP management in pre- and stage-1 hypertensive individuals.

Electronic supplementary material

The online version of this article (10.1007/s00394-020-02279-0) contains supplementary material, which is available to authorized users.

The association of resting postoperative systolic, diastolic, and mean blood pressure and pulse pressure with short- and long-term mortality in patients with acute coronary syndrome undergoing primary percutaneous coronary intervention

BACKGROUND

Admission blood pressure was closely associated with adverse cardiac events in acute coronary syndrome (ACS) patients. However, data regarding comparison of resting postoperative systolic, diastolic, and mean blood pressure and pulse pressure with short- and long-term mortality in patients with acute coronary syndrome undergoing primary percutaneous coronary intervention (PCI) was still lacking.

METHODS

The study analyzed 1987 ACS patients undergoing primary PCI, between January 2014 and October 2018. The primary outcomes were in-hospital cardiac and long-term all-cause mortality.

RESULTS

Bar tendency chart and adjusted odds ratios showed that the resting postoperative SBP≤100 mmHg, PP≤30 mmHg and MAP≤70 mmHg have higher in-hospital cardiac (SBP: adjusted OR=9.42, 95% CI: 1.95-45.53, P<0.01; PP: adjusted OR=8.61, 95% CI: 2.53-29.30, P<0.01; MAP: adjusted OR=4.01, 95% CI: 1.61-9.98, P<0.01) and long-term all-cause mortality (SBP: adjusted HR=4.18, 95% CI: 1.43-12.23, P<0.01; PP: adjusted HR=3.71, 95% CI: 1.66-8.24, P<0.01; MAP: adjusted HR=2.54, 95% CI: 1.14-5.65, P<0.01), and the relationship between resting postoperative SBP and in-hospital cardiac or long-term all-cause mortality seemed to follow a J-shaped curve with increased event rates at low and high groups.

CONCLUSIONS

The resting postoperative SBP≤100 mmHg, PP≤30 mmHg and MAP≤70 mmHg are independent adverse prognosticators in ACS patients undergoing primary PCI, and the relationship between SBP and mortality looks like a J-shaped curve.

U-shaped association of central pulse pressure with long-term prognosis after ST-segment elevation myocardial infarction

The relationship between central pulse pressure (CPP) measured at the time of primary percutaneous coronary intervention (PPCI) and long-term prognosis after ST-segment elevation myocardial infarction (STEMI) has not been investigated. CPP measurements were performed in 1348 patients with STEMI (327 women; mean age 62.5 ± 12.1 years) undergoing PPCI. Aortic systolic and diastolic blood pressure was measured before intervention. The primary outcome was 8-year all-cause mortality. The median [25-75th percentile] CPP value was 55.0 [43.0-70.0] mmHg. CPP correlated negatively with heart rate (P < 0.001), body mass index (P = 0.007), Killip class (P < 0.001) and initial area at risk (P < 0.001) and positively with age (P < 0.001), female sex (P < 0.001), diabetes (P = 0.012), arterial hypertension (P < 0.001) and glomerular filtration rate (P = 0.004). There were 181 deaths over the follow-up. In patients with CPP within the 1st, 2nd and 3rd tertiles, the Kaplan-Meier estimates of mortality were 17.3%, 10.8% and 24.2%, respectively; univariable hazard ratio [HR] =1.52, 95% confidence interval [CI] 0.99 to 2.32; P = 0.055 for tertile 1 vs. tertile 2 and HR =2.09 [1.36-3.21]; P < 0.001 for tertile 3 vs. tertile 2. For CPP values lower than 35 mmHg and higher than 71 mmHg, the association between CPP and all-cause mortality was significant (HR =1.276 [1.004-1.621] for the 35 mmHg value and HR =1.289 [1.003-1.657] for the 71 mmHg value) compared with the CPP reference value (54 mmHg). After adjustment, the association between CPP and all-cause mortality was attenuated (P = 0.304). In patients with STEMI undergoing PPCI there is a U-shaped association between CPP and mortality up to 8 years after PPCI.