Abstract 11580: Brachial Pulse Pressure Predicts Adverse Outcomes Including Heart Failure Hospitalizations in Women With Preserved Ejection Fraction and No Obstructive Coronary Artery Disease: A Report from the Women’s Ischemia Syndrome Evaluation
Introduction: Systemic arterial pulse pressure (PP) estimates pulsatile load and arterial stiffness and predicts cardiac events. The Women’s Ischemia Syndrome Evaluation (WISE) found that women with suspected ischemic heart disease (IHD) have increased cardiac event rates, particularly heart failure events, despite no obstructive CAD and preserved left ventricular ejection fraction (LVEF). The long-term prognostic value of PP among women with suspected IHD has not been fully studied.
Hypothesis: Brachial PP is an independent risk factor for adverse outcomes including heart failure events in women with suspected IHD, no obstructive CAD, and preserved LVEF.
Methods: We investigated 549 women with no obstructive CAD from WISE with 10-year (median) follow up. The primary outcome (PO) was time to first occurrence of death, non-fatal MI, non-fatal stroke, or heart failure event. The secondary outcome (SO) was time to first occurrence of death or heart failure event. PP was dichotomized with ROC analysis to define optimal sensitivity and specificity in predicting the PO. KM survival analysis and Cox PH were used to compare freedom from outcomes in both PP groups and determine adjusted hazard ratios (HRs).
Results: Baseline mean age was 56±11; 96(17%) were non-white; mean LVEF was 67±10, 89(16%) had DM. Optimal PP for predicting the PO was 62.5 mmHg, with AUC of 0.614. Event rates, adjusted HRs, and KM curves are shown.
Conclusions: The increased event rate seen in women with suspected IHD, no obstructive coronary disease, and preserved LVEF can be further prognosticated using PP as an independent risk factor for adverse outcomes including death or heart failure events over the long term.
Author Disclosures: J.R. Vilaro: None. T. Huo: None. R.M. Cooper-DeHoff: None. E. Handberg: None. G. Sopko: None. S. Kelsey: None. N. Bairey Merz: Honoraria; Modest; Mayo Foundation (lectures), Bryn Mawr Hospital (lectures), Practice Point Communications (lectures), Allegheny General Hospital (lectures), Duke (lecture), Gilead (lecture), Japanese Circ Society (lectures), UCSF (lectures), ox Media (lectures), Emory (lectures), PCNA (lectures), Kaiser Permanente (lectures), Garden State AHA, Victor Change Cardiac Research Institute (Australia), University of New Mexico, NIH-SEP (grant review study section). Consultant/Advisory Board; Significant; Research Triangle Institute (RTI) International. C.J. Pepine: Research Grant; Modest; Cytori, AHA, NHLBI/CTSA, Amorcyte/Neostem, InfraReDx, NIH/NHLBI. Research Grant; Significant; Pfizer, Park-Davis, Brigham & Women’s Hospital, Fujisawa HealthCare Inc., Gilead Sciences, Baxter, Astrazeneca, Sanofi-Aventis (educational grant). Honoraria; Modest; NIH Study Section CV Sciences & Small Business Activities, NHLBI Study Section, Progenitor Cell Biology Consortium, NHLBI DSMB Chair for Freedom Trial, Medtelligence, Lilly/Cleveland Clinic DSMB member for Phase 2 Efficacy & Safety study.
- © 2014 by American Heart Association, Inc.