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Heart failure and cardiomyopathies
Original research
Pulse pressure and aortic valve peak velocity and incident heart failure after myocardial infarction: a cohort study
  1. Yuzhong Wu1,2,
  2. Jingjing Zhao1,2,
  3. Chen Chen1,2,
  4. Jiale Huang1,2,
  5. Weihao Liang1,2,
  6. Jiayong Li1,2,
  7. Yugang Dong1,2,
  8. Chen Liu1,2,3,
  9. Ruicong Xue1,2,3
  1. 1 Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
  2. 2 Key Laboratory of Assisted Circulation and Vascular Diseases, Chinese Academy of Medical Sciences, Guangzhou, China
  3. 3 National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
  1. Correspondence to Dr Ruicong Xue; xrcgrayson{at}163.com

Abstract

Background Heart failure with preserved ejection fraction is a recognised outcome in patients with myocardial infarction, although heart failure with reduced ejection fraction is more common. Identifying early indicators specific to heart failure with preserved ejection fraction in patients with myocardial infarction could support targeted preventive strategies. This study aimed to determine if pulse pressure and aortic valve peak velocity could serve as early predictors of heart failure with preserved ejection fraction in patients with myocardial infarction.

Methods We retrospectively analysed data from 5188 participants in the Atherosclerosis Risk in Communities Study who were free from heart failure at baseline, including 802 individuals with a history of myocardial infarction. Heart failure events were classified as either heart failure with preserved ejection fraction (left ventricular ejection fraction ≥50%) or heart failure with mildly reduced or reduced ejection fraction (left ventricular ejection fraction <50%). Competing risk regression models were used to examine associations of baseline pulse pressure and aortic valve peak velocity with heart failure subtypes.

Results Over 6 years of follow-up, 217 cases of heart failure with preserved ejection fraction (including 50 in patients with myocardial infarction) and 127 cases of heart failure with mildly reduced or reduced ejection fraction (33 in patients with myocardial infarction) were identified. Among patients with myocardial infarction, a 1-SD increase in pulse pressure was associated with a 1.60-fold higher risk of heart failure with preserved ejection fraction (95% CI 1.30 to 1.97), and a similar association was observed for aortic valve peak velocity (HR: 1.37, 95% CI 1.19 to 1.58). Patients with pulse pressure ≥68 mm Hg had a 3.83-fold higher risk of heart failure with preserved ejection fraction compared with those with lower pulse pressure, and those with aortic valve peak velocity ≥1.4 m/s had a 2.10-fold higher risk compared with those with lower values. Patients with myocardial infarction with two or more risk factors among elevated pulse pressure, aortic valve peak velocity, diabetes and atrial fibrillation had over 16 times the risk of developing heart failure with preserved ejection fraction compared with those without these risk factors (p<0.001).

Conclusions Pulse pressure and aortic valve peak velocity are significant predictors of heart failure with preserved ejection fraction in patients with myocardial infarction, suggesting their potential value in early risk stratification. These findings support the use of these markers to guide timely interventions aimed at preventing the progression to heart failure with preserved ejection fraction.

  • Heart failure
  • Myocardial Infarction
  • Cohort Studies
  • Heart Failure, Diastolic
  • Risk Factors

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/heartjnl-2024-324517

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • YW and JZ are joint first authors.

    • CL and RX contributed equally.

    • Contributors Under the direction of RX and CL, YW and JZ performed the study design, data extraction, and statistical analysis. YW wrote the original draft, while JH and WL revised the draft. All other authors checked the data to ensure accuracy and edited the manuscript prior to submission to ensure the precise demonstration. RX is the guarantor.

    • Funding This study was funded by Key R&D Projects of Guangzhou Science and Technology Program (2023B01J1011), National Natural Science Foundation of China (82270399 and 82200415), Guangdong Natural Science Foundation (2022A1515012161 and 2022A1515010227), Guangdong Basic and Applied Basic Research Foundation (2022A1515111120 and 2023A1515111097), Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences (2023-PT320-03) and Chinese Society of Cardiology’s Foundation (CSCF2022B06).

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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