Pulse pressure and QRS width evaluation as an inexpensive tool for heart failure assessment.
Decreased pulse pressure (PP) is associated with low cardiac output and increased mortality in heart failure (HF) inpatients. QRS width is a well-known prognostic factor in HF. The study purpose was to explore the mortality effect of combining PP and QRS width in HF outpatients. Initial sphygmomanometrically determined PP and QRS width on the first electrocardiograph in 327 consecutive patients at an HF clinic were recorded. According to PP > or = or <40 mm Hg and QRS width > or = or <120 ms, patients were classified into 4 groups. Study groups were analyzed for their effect on mortality using Cox proportional hazards regression analysis. Patients with PP <40 mm Hg had higher mortality (59% vs 45%; P=.015). QRS width > or =120 ms indicated a trend toward higher mortality (57% vs 48%; P=.067). Actuarial survival curves showed that group 4 (QRS width > or =120 ms and PP <40 mm Hg) had significant increased mortality risk in 3.5 years' mean follow-up. Group 4 had a mean survival time of 1124 days (SD=124) vs 2233 days (SD=285) in group 1 (QRS width <120 ms and PP > or =40 mm Hg) (P=.022). There was a linear association between left ventricular ejection fraction (LVEF) and study groups. PP and QRS width are readily available, inexpensive, and relevant clinical measures to help identify HF outpatients with significantly worse prognosis and decreased LVEF.
Beck-da-Silva
Luís
L
Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre-RS, Brazil. lbneto@hcpa.ufrgs.br
Goldraich
Lívia
L
Bonzanini
Laísa
L
Rossi
Gabriela
G
Nuernberg
Gabriela
G
Camey
Suzi A
SA
Rohde
Luís Eduardo
LE
Clausell
Nadine
N
D000704:Analysis of Variance; D001794:Blood Pressure; D001938:Brazil; D002302:Cardiac Output; D002316:Cardiotonic Agents / Q000627:therapeutic use; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012044:Regression Analysis; D018570:Risk Assessment; D019722:Sphygmomanometers; D013318:Stroke Volume; D016277:Ventricular Function, Left
D002316:Cardiotonic Agents