Original Article
Pulse pressure can predict mortality in advanced heart failure
Pressão de pulso pode ser um preditor de mortalidade na insuficiência cardíaca avançada
Ana Rita Ferreira
, Sofia Mendes, Luís Leite, Sílvia Monteiro, Mariano Pego
Autor para correspondência
Serviço de Cardiologia A, Centro Hospitalar e Universitário de Coimbra, Hospitais da Universidade de Coimbra, Coimbra, Portugal
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array:2 [ "nombre" => "Mariano" "apellidos" => "Pego" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Serviço de Cardiologia A, Centro Hospitalar e Universitário de Coimbra, Hospitais da Universidade de Coimbra, Coimbra, Portugal" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Pressão de pulso pode ser um preditor de mortalidade na insuficiência cardíaca avançada" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1869 "Ancho" => 1640 "Tamanyo" => 87481 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Kaplan-Meier analysis showing that group 2 had higher mortality.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Pulse pressure (PP) is the difference between systolic and diastolic blood pressure (BP) and is dependent on stroke volume and arterial wall elastic properties.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In a young healthy person, each stroke volume received into the central vessels is accommodated by a stretching of these vessels in systole followed by subsequent elastic recoil in late systole and diastole. This is known as arterial compliance and has the effect of maintaining central and peripheral BP within a relatively narrow range. With aging, there is a disruption and fragmentation of the elastic lamellae of the central arteries, as well as alteration of the collagen-to-elastin ratio, leading to arterial stiffness, loss of compliance, and increased pulse wave velocity and therefore increased PP.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">An elevated PP consistently predicts increased cardiovascular (CV) risk, including for coronary heart disease, chronic heart failure (HF) and CV mortality.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The prognostic value of PP in patients with chronic HF is less clear. The SOLVD investigators found that a high PP predicted adverse outcome, especially in patients in New York Heart Association (NYHA) class II or III.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> In contrast, in patients hospitalized with acute HF, low PP appeared to be an independent predictor of mortality. A low PP (≤40 mmHg) may represent a decrease in cardiac output and reflect a reduction of stroke volume due to left ventricular dysfunction.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The aim of this study was to assess whether PP can be used as a prognostic marker in advanced HF (NYHA class III or IV).</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">We retrospectively studied 914 patients in NYHA class III–IV hospitalized in a single advanced HF unit between January 2003 and August 2012.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Detailed histories of the patients including demographic characteristics, CV risk factors and medication were recorded.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Serum lipid, glucose, creatinine, sodium, potassium, and brain natriuretic peptide levels were measured by routine laboratory methods.</p><p id="par0045" class="elsevierStylePara elsevierViewall">PP was calculated as the difference between systolic and diastolic BP at admission, and the patients were divided into two groups (group 1: PP >40 mmHg and group 2: PP ≤40 mmHg).</p><p id="par0050" class="elsevierStylePara elsevierViewall">Median follow-up was 666±50 days for the occurrence of CV death (sudden cardiac death or death due to decompensated HF, acute coronary syndrome or arrhythmia) and heart transplantation.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Statistical analysis</span><p id="par0055" class="elsevierStylePara elsevierViewall">All analyses were performed with SPSS 16.0. Continuous variables were presented as mean ± standard error of the mean. Continuous variables according to NYHA class or PP group were analyzed by means.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The Student's t test or Mann-Whitney test was used for binary dependent variables. A p value <0.05 was considered statistically significant.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Differences between survival curves were calculated using univariate log-rank survival analysis.</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0070" class="elsevierStylePara elsevierViewall">During follow-up 914 patients in NYHA class III–IV were hospitalized, 520 in group 1 and 394 in group 2. Median follow-up was nearly two years.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Patients’ baseline characteristics are presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">There were no significant differences between patients with lower and higher PP. Mean age was similar and most patients were male in both groups. There were also no differences in medication or CV risk factors.</p><p id="par0085" class="elsevierStylePara elsevierViewall">The most important difference between the groups was in left ventricular dysfunction, which was greater in patients with lower PP. Length of hospital stay was greater in group 2, although without statistically significant difference.</p><p id="par0090" class="elsevierStylePara elsevierViewall">On Kaplan-Meier analysis (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>), group 2 had higher mortality (38 vs. 24 patients, log-rank p=0.002).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0095" class="elsevierStylePara elsevierViewall">Our study showed that low PP predicted CV death in patients with advanced HF. Furthermore, low PP was closely associated with worsening left ventricular ejection fraction (LVEF).<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">PP has been previously correlated with arterial compliance and with hemodynamic factors such as stroke volume and peak aortic blood flow. Left ventricular systolic dysfunction reduces stroke volume and therefore also PP and systolic BP. Several studies have shown a positive correlation between low PP and diminished cardiac index (<2.2 l/min/m<span class="elsevierStyleSup">2</span>). Voors et al. reported a positive and independent association between low PP and low LVEF, and our results confirm these observations.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">There are well recognized factors that affect mortality in HF, such as older age, diabetes, renal failure, higher NYHA class, low LVEF, low peak oxygen consumption, low plasma sodium levels and high natriuretic peptides. In our study low PP and low LVEF were the most important predictors of CV death.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">The data on the relationship between PP and HF prognosis are limited and controversial. In two large trials, high PP predicted adverse CV outcomes in mild HF patients. The SAVE investigators<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> showed that higher PP predicted worse outcome in patients with asymptomatic LV systolic dysfunction, and the SOLVD investigators<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> reported that high PP was an independent predictor of total CV death in patients with mild HF. Other investigators showed that low PP independently predicted higher CV mortality in patients with advanced and decompensated HF, but not in patients with mild HF. Voors et al.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> proposed that low PP indicated decreased cardiac function. In another study PP only appeared to be an independent predictor of CV death in non-ischemic HF.</p><p id="par0115" class="elsevierStylePara elsevierViewall">The differences between findings on the prognostic value of PP may be due to different characteristics of the study populations. In mild HF, a high PP is probably the result of vascular stiffening or decreased aortic elasticity, which indicates atherosclerosis and therefore a poorer prognosis, whereas in advanced HF, low PP indicates decreased cardiac function and an associated worse prognosis, as demonstrated in our study.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">4,5</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusion</span><p id="par0120" class="elsevierStylePara elsevierViewall">PP is easily calculated and can provide a clinical prognostic indicator in patients hospitalized for advanced HF.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Ethical disclosures</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Protection of human and animal subjects</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Confidentiality of data</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Right to privacy and informed consent</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicts of interest</span><p id="par0140" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres624339" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec637789" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres624340" "titulo" => "Resumo" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introdução" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusões" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec637788" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0030" "titulo" => "Conclusion" ] 9 => array:3 [ "identificador" => "sec0035" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0050" "titulo" => "Right to privacy and informed consent" ] ] ] 10 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflicts of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-07-18" "fechaAceptado" => "2015-11-21" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec637789" "palabras" => array:3 [ 0 => "Pulse pressure" 1 => "Heart failure" 2 => "Left ventricular dysfunction" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec637788" "palabras" => array:3 [ 0 => "Pressão de pulso" 1 => "Insuficiência cardíaca" 2 => "Disfunção ventricular esquerda" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Pulse pressure (PP) is the difference between systolic and diastolic blood pressure (BP). PP rises markedly after the fifth decade of life. High PP is a risk factor for the development of coronary heart disease and heart failure. The aim of this study was to assess whether PP can be used as a prognostic marker in advanced heart failure.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We retrospectively studied patients in NYHA class III–IV who were hospitalized in a single heart failure unit between January 2003 and August 2012. Demographic characteristics, laboratory tests, and cardiovascular risk factors were recorded. PP was calculated as the difference between systolic and diastolic BP at admission, and the patients were divided into two groups (group 1: PP >40 mmHg and group 2: PP ≤40 mmHg). Median follow-up was 666±50 days for the occurrence of cardiovascular death and heart transplantation.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">During follow-up 914 patients in NYHA class III–IV were hospitalized, 520 in group 1 and 394 in group 2. The most important difference between the groups was in left ventricular dysfunction, which was greater in patients with lower PP. On Kaplan-Meier analysis, group 2 had higher mortality (38 vs. 24 patients, log-rank p=0.002).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">PP is easily calculated, and enables prediction of cardiovascular death in patients with advanced heart failure.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "pt" => array:3 [ "titulo" => "Resumo" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introdução</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A pressão de pulso (PP) é a diferença entre os valores da pressão arterial sistólica e diastólica (BP). A PP sobe acentuadamente após a quinta década de vida, sendo considerada um fator de risco para o desenvolvimento de doenças cardiovasculares. O objetivo do estudo foi avaliar se a PP pode ser usada como um marcador de prognóstico em doentes com insuficiência cardíaca avançada.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Foram estudados, retrospetivamente, 914 doentes em classe III-IV de NYHA, que foram internados numa unidade de insuficiência cardíaca, entre janeiro de 2003 e agosto de 2012. Foram recolhidos: características demográficas, análises laboratoriais e fatores de risco cardiovascular dos doentes incluídos. A PP foi calculada como a diferença entre a BP na admissão e os doentes foram divididos em dois grupos (PP > 40 mmHg e PP = 40 mmHg). O tempo médio de <span class="elsevierStyleItalic">follow-up</span> foi de 666 ± 50 dias. Os <span class="elsevierStyleItalic">endpoints</span> considerados foram a morte por causa cardiovascular e o transplante cardíaco.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Durante o <span class="elsevierStyleItalic">follow-up</span> foram internados 914 doentes, sendo divididos em dois grupos: grupo I: PP > 40 mmHg (520 pacientes); grupo II: PP = 40 mmHg (394 pacientes). A diferença mais importante entre os grupos foi a depressão da função ventricular esquerda mais acentuada no grupo de doentes com PP menor. Na análise KaplanMeyer, o grupo II (PP = 40 mmHg) apresentou maior mortalidade (38 pacientes <span class="elsevierStyleItalic">versus</span> 24 pacientes, <span class="elsevierStyleItalic">log-rank</span> P = 0,002).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusões</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A PP é um parâmetro facilmente calculado que se correlaciona com o prognóstico dos doentes com insuficiência cardíaca avançada.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introdução" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusões" ] ] ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1869 "Ancho" => 1640 "Tamanyo" => 87481 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Kaplan-Meier analysis showing that group 2 had higher mortality.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">BNP: brain natriuretic peptide; HF: heart failure; LVEF: left ventricular ejection fraction; PP: pulse pressure; SEM: standard error of the mean.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group 1: PP >40 mmHg (n=520) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group 2: PP ≤40 mmHg (n=394) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PP (mean ± SEM) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33.5 (0.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55.5 (0.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.005 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age, years (mean; range) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61 (14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58 (14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Male, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">71.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">74.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Female, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LVEF, % (mean ± SEM) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 (13.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 (10.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Heart rate, bpm (mean ± SEM) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">81 (17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75 (13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BNP, pg/ml (mean ± SEM) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">830 (742) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1121 (866) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chronic HF (n) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">403 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">313 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Acute HF (n) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cardiogenic shock (n) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Right HF (n) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hospital stay, days (mean ± SEM) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hypertension (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dyslipidemia (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">74.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">85 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Type 2 diabetes (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1024219.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Demographic characteristics.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ESH/ESC Guidelines for the management of arterial hypertension" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G. Mancia" 1 => "R. Fagard" 2 => "K. Narkiewicz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/eht151" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2013" "volumen" => "34" "paginaInicial" => "2159" "paginaFinal" => "2219" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23771844" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0045" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulse pressure: why is it important?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.F. Malone" 1 => "D.N. Reddan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3747/pdi.2010.00002" "Revista" => array:6 [ "tituloSerie" => "Perit Dial Int" "fecha" => "2010" "volumen" => "30" "paginaInicial" => "265" "paginaFinal" => "268" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20424194" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0050" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Low pulse pressure as a predictor of death in patients with mild to advanced heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "T. Yildrian" 1 => "M. Koc" 2 => "A. 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Petrie" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehi270" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2005" "volumen" => "26" "paginaInicial" => "1759" "paginaFinal" => "1764" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15833758" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0060" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sphygmomanometrically determined pulse pressure is a powerful independent predictor of recurrent events after myocardial infarction in patients with impaired left ventricular function. SAVE investigators. Survival and ventricular enlargement" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G.F. Mitchell" 1 => "L.A. Moye" 2 => "E. Braunwald" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "1997" "volumen" => "96" "paginaInicial" => "4254" "paginaFinal" => "4260" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9416890" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0065" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Independent prognostic information provided by sphygmomanometrically determined pulse pressure and mean arterial pressure in patients with left ventricular dysfunction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M.J. Domanski" 1 => "G.F. Mitchell" 2 => "J.E. 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| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 6 | 7 | 13 |
| 2024 Outubro | 44 | 23 | 67 |
| 2024 Setembro | 50 | 21 | 71 |
| 2024 Agosto | 40 | 24 | 64 |
| 2024 Julho | 49 | 31 | 80 |
| 2024 Junho | 38 | 24 | 62 |
| 2024 Maio | 32 | 15 | 47 |
| 2024 Abril | 38 | 26 | 64 |
| 2024 Maro | 36 | 21 | 57 |
| 2024 Fevereiro | 32 | 30 | 62 |
| 2024 Janeiro | 28 | 31 | 59 |
| 2023 Dezembro | 32 | 20 | 52 |
| 2023 Novembro | 29 | 23 | 52 |
| 2023 Outubro | 19 | 12 | 31 |
| 2023 Setembro | 24 | 22 | 46 |
| 2023 Agosto | 38 | 22 | 60 |
| 2023 Julho | 43 | 12 | 55 |
| 2023 Junho | 29 | 8 | 37 |
| 2023 Maio | 45 | 23 | 68 |
| 2023 Abril | 23 | 6 | 29 |
| 2023 Maro | 30 | 23 | 53 |
| 2023 Fevereiro | 34 | 18 | 52 |
| 2023 Janeiro | 17 | 11 | 28 |
| 2022 Dezembro | 29 | 18 | 47 |
| 2022 Novembro | 45 | 29 | 74 |
| 2022 Outubro | 23 | 16 | 39 |
| 2022 Setembro | 23 | 26 | 49 |
| 2022 Agosto | 27 | 31 | 58 |
| 2022 Julho | 32 | 29 | 61 |
| 2022 Junho | 22 | 25 | 47 |
| 2022 Maio | 16 | 28 | 44 |
| 2022 Abril | 33 | 35 | 68 |
| 2022 Maro | 17 | 22 | 39 |
| 2022 Fevereiro | 20 | 28 | 48 |
| 2022 Janeiro | 26 | 29 | 55 |
| 2021 Dezembro | 24 | 26 | 50 |
| 2021 Novembro | 27 | 33 | 60 |
| 2021 Outubro | 36 | 38 | 74 |
| 2021 Setembro | 24 | 28 | 52 |
| 2021 Agosto | 37 | 26 | 63 |
| 2021 Julho | 27 | 22 | 49 |
| 2021 Junho | 32 | 22 | 54 |
| 2021 Maio | 32 | 27 | 59 |
| 2021 Abril | 38 | 31 | 69 |
| 2021 Maro | 80 | 24 | 104 |
| 2021 Fevereiro | 65 | 21 | 86 |
| 2021 Janeiro | 42 | 19 | 61 |
| 2020 Dezembro | 35 | 15 | 50 |
| 2020 Novembro | 35 | 15 | 50 |
| 2020 Outubro | 24 | 19 | 43 |
| 2020 Setembro | 82 | 21 | 103 |
| 2020 Agosto | 45 | 7 | 52 |
| 2020 Julho | 41 | 9 | 50 |
| 2020 Junho | 65 | 15 | 80 |
| 2020 Maio | 52 | 6 | 58 |
| 2020 Abril | 48 | 13 | 61 |
| 2020 Maro | 69 | 12 | 81 |
| 2020 Fevereiro | 176 | 23 | 199 |
| 2020 Janeiro | 98 | 8 | 106 |
| 2019 Dezembro | 59 | 12 | 71 |
| 2019 Novembro | 40 | 15 | 55 |
| 2019 Outubro | 59 | 5 | 64 |
| 2019 Setembro | 35 | 5 | 40 |
| 2019 Agosto | 41 | 9 | 50 |
| 2019 Julho | 42 | 12 | 54 |
| 2019 Junho | 36 | 10 | 46 |
| 2019 Maio | 30 | 6 | 36 |
| 2019 Abril | 33 | 15 | 48 |
| 2019 Maro | 36 | 17 | 53 |
| 2019 Fevereiro | 33 | 10 | 43 |
| 2019 Janeiro | 33 | 7 | 40 |
| 2018 Dezembro | 51 | 11 | 62 |
| 2018 Novembro | 181 | 13 | 194 |
| 2018 Outubro | 266 | 18 | 284 |
| 2018 Setembro | 106 | 13 | 119 |
| 2018 Agosto | 58 | 16 | 74 |
| 2018 Julho | 25 | 8 | 33 |
| 2018 Junho | 46 | 10 | 56 |
| 2018 Maio | 34 | 17 | 51 |
| 2018 Abril | 24 | 3 | 27 |
| 2018 Maro | 60 | 12 | 72 |
| 2018 Fevereiro | 28 | 10 | 38 |
| 2018 Janeiro | 28 | 9 | 37 |
| 2017 Dezembro | 58 | 9 | 67 |
| 2017 Novembro | 50 | 12 | 62 |
| 2017 Outubro | 23 | 9 | 32 |
| 2017 Setembro | 23 | 5 | 28 |
| 2017 Agosto | 27 | 11 | 38 |
| 2017 Julho | 21 | 10 | 31 |
| 2017 Junho | 34 | 12 | 46 |
| 2017 Maio | 23 | 7 | 30 |
| 2017 Abril | 26 | 4 | 30 |
| 2017 Maro | 20 | 14 | 34 |
| 2017 Fevereiro | 22 | 6 | 28 |
| 2017 Janeiro | 23 | 4 | 27 |
| 2016 Dezembro | 33 | 7 | 40 |
| 2016 Novembro | 25 | 5 | 30 |
| 2016 Outubro | 25 | 4 | 29 |
| 2016 Setembro | 24 | 8 | 32 |
| 2016 Agosto | 19 | 8 | 27 |
| 2016 Julho | 15 | 10 | 25 |
| 2016 Junho | 5 | 22 | 27 |
| 2016 Maio | 7 | 73 | 80 |
| 2016 Abril | 119 | 45 | 164 |
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