Elevation in systolic blood pressure during heart failure hospitalization is associated with increased short and long-term mortality

Modified reverse shock index predicts early outcomes of heart failure with reduced ejection fraction

AIMS

Increased blood pressure (BP) and decreased heart rate (HR) are signs of stabilization in patients admitted for acute HF. Changes in BP and HR during admission and their correlation with outcomes were assessed in hospitalized patients with heart failure (HF) with reduced ejection fraction (HFrEF).

METHODS

A novel modified reverse shock index (mRSI), defined as the ratio between changes in systolic BP and HR during admission, was devised, and its prognostic value in the early outcomes of acute HF was assessed using the Korean Acute HF registry.

RESULTS

Among 2697 patients with HFrEF (mean age 65.8 ± 14.9 years, 60.6% males), patients with mRSI ≥1.25 at discharge were significantly younger and were more likely to have de novo HF. An mRSI ≥1.25 was associated with a significantly lower incidence of 60-day and 180-day all-cause mortality [hazard ratio (HR) 0.49, 95% confidence interval (CI) 0.31-0.77; HR 0.62, 95% CI 0.45-0.85, respectively], compared with 1 ≤ mRSI < 1.25 (all P < 0.001). Conversely, an mRSI <0.75 was associated with a significantly higher incidence of 60-day and 180-day all-cause mortality (adjusted HR 2.08, 95% CI 1.19-3.62; HR 2.24, 95% CI 1.53-3.27; all P < 0.001). The benefit associated with mRSI ≥1.25 was consistent in sub-group analyses. The correlation of mRSI and outcomes were also consistent regardless of admission SBP, presence of atrial fibrillation, or use of beta blockers at discharge.

CONCLUSIONS

In patients hospitalized for HFrEF, the mRSI was a significant predictor of early outcomes. The mRSI could be used as a tool to assess patient status and guide physicians in treating patients with HFrEF.

Early pregnancy stage 1 hypertension and high mean arterial pressure increased risk of adverse pregnancy outcomes in Shanghai, China

We aimed to evaluate the influence of early pregnancy stage 1 hypertension and mean arterial pressure (MAP) on the risk of pregnancy complications, including gestational diabetes mellitus (GDM) and adverse pregnancy outcomes. Pregnant women without early pregnancy hypertension were consecutively recruited in 2010 in Shanghai, China. Total 6104 women with blood pressure (BP) <140/90 mmHg were categorized according to early pregnancy BP and MAP levels, respectively. Multivariate adjusted logistic regression and cox regression was used to test the potential associations. Finally 313 (5.1%) pregnant women identified as stage 1 hypertension. Compared with normotensive women, women with early pregnancy stage 1 hypertension increased the risk of gestational hypertension (GH) [Adjust odds ratio (AOR) 2.295, 95% confidence interval (CI) 1.578-3.338], GDM [AOR 1.185, 95% CI 1.010-1.391], preeclampsia [AOR 2.295 95% CI 1.578-3.338], preterm delivery [AOR 1.326, 95% CI 1.026-1.713]and infants with low-birth weight [AOR 1.487, 95% CI 1.082-2.045]; Compared women with MAP < 76 mmHg, the risk of GDM increased, with an adjust hazard ratio (AHR) of 1.387 (95%CI 1.048-1.835) for 76 ≤ MAP < 88 mmHg and an AHR of 1.451 (95%CI 1.053-1.998) for MAP ≥ 88 mmHg. Especially, high MAP levels (≥ 88 mmHg) are associated with GH [AOR 2.775, 95%CI 1.805-4.266], preeclampsia [AOR 3.936, 95%CI 2.358-6.570] and preterm delivery [AOR 1.412, 95%CI 1.035-1.926]. In summary early pregnancy stage 1 hypertension is associated with adverse pregnancy outcomes. Relative higher BP levels in early pregnancy, especially elevated MAP levels should be aware by clinicians to decrease the risk of pregnancy complications.

Gender Differences in Prognostic Markers of All-Cause Death in Patients with Acute Heart Failure: a Prospective 18-Month Follow-Up Study

Acute heart failure (AHF) is a life-threatening condition with poor prognosis. Gender differences have been increasingly recognized in diverse cardiovascular diseases. The present study aimed to evaluate gender-specific prognostic markers of all-cause death in AHF patients based on a prospective 18-month follow-up study. Data were collected from 419 patients with AHF hospitalization who were followed up for 18 months using all-cause death as primary endpoint. The mean age of all patients was 60.9 ± 15.7 years old, 277 were males, and 142 were females. Females had higher rate of valvular heart disease (37.3%) and atrial fibrillation (45.8%) but lower rate of cardiomyopathy (30.3%) than males in this cohort. Based on multiple COX stepwise regression and ROC curve analysis, diastolic blood pressure (DBP), serum sodium, serum creatinine, and pulmonary artery systolic pressure (PASP) were identified as independent predictors of all-cause death in male AHF patients, while systolic blood pressure (SBP), serum aspartate transaminase (AST), serum creatinine, and serum D-dimer as independent predictors in females. Kaplan-Meier analysis showed a higher probability of all-cause death over time in male AHF patients with DBP ≤ 77 mmHg, serum sodium ≤ 138.5 mM, serum creatinine ≥ 126.2 μM, or PASP ≥ 52 mmHg, and in female AHF patients with SBP ≤ 129 mmHg, serum AST > 29.3 U/L, serum creatinine ≥ 102.7 μM, or serum D-dimer ≥ 1.76 mg/L. In conclusion, these data provide novel insights into gender differences in prognostic markers of outcomes of AHF patients.