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Association of pulse pressure and aortic root diameter in elderly Chinese patients with chronic heart failure
Lu Chen1, Wenhui Xie1, Xuhui Hong1
1Department of Geriatrics, Fujian Key Laboratory of Vascular Aging, Fujian Institute of Geriatrics, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.
Insights
Pulse pressure (PP) is linked to aortic root diameter (AoD) in elderly heart failure with reduced ejection fraction (HFrEF) patients, suggesting vascular aging contributes to aortic dilation in this group.
Area of Science:
- Cardiology
- Vascular Biology
- Geriatrics
Background:
- High pulse pressure (PP) and aortic root diameter (AoD) are indicators of vascular aging and risk factors for cardiovascular disease, including heart failure (HF).
- The specific relationship between PP and AoD in HF patients remains unclear.
- This study investigated the association between PP and AoD in middle-aged and elderly individuals with HF.
Purpose of the Study:
- To evaluate the relationship between pulse pressure and aortic root diameter in middle-aged and elderly patients with heart failure.
- To identify factors associated with aortic root diameter in heart failure patients.
- To determine the risk of aortic root dilation based on pulse pressure levels.
Main Methods:
- A total of 1,027 Chinese patients with heart failure (HFrEF, HFmrEF, HFpEF) were analyzed.
- Pearson correlation, multiple linear regression, and multivariate logistic regression were employed.
- The findings were validated in an independent cohort of 378 HFrEF patients.
Main Results:
- A positive correlation was found between PP and AoD in middle-aged and elderly HFrEF patients.
- PP, age, and BMI were independently associated with AoD in HFrEF.
- Increased aortic root dilation risk was observed in the highest PP quartile, particularly in patients aged 65 and older.
Conclusions:
- Pulse pressure is independently and positively associated with aortic root diameter, especially in elderly HFrEF patients.
- This association was not significant in HFmrEF or HFpEF patients.
- Arterial stiffening and vascular aging likely contribute to aortic dilation in elderly HFrEF patients.
Background:
High pulse pressure (PP) and aortic root diameter (AoD) are hallmarks of arterial stiffness or vascular aging and they are considered as risk factors for age-related cardiovascular disease, including heart failure (HF). However, the relationship between PP and AoD in patients with heart failure (HF) is uncertain. This study aimed to evaluate the relationship between PP and AoD in the middle-aged and the elderly with HF.
Methods:
A total of 1,027 Chinese middle-aged and elderly patients with HF, including HF with reduced ejection fraction (HFrEF), HF with mid-range EF (HFmrEF), and HF with preserved EF (HFpEF) were included in this study. Pearson correlation analysis was used to evaluate the relationship between PP and AoD in the three types of HF. Multiple linear regression analysis was performed to assess the factors that affected AoD. Multivariate logistic regression was performed to determine the association between the PP level quartiles and AoD. The results were validated in an independent dataset included a total of 378 consecutive patients with HFrEF hospitalized at the Pingtan Branch of Fujian Medical University Union Hospital (Fujian, China).
Results:
There was a positive correlation between PP and AoD in the middle-aged and the elderly with HFrEF. Multiple linear regression analysis revealed that PP, age, and body mass index (BMI) were independently correlated with AoD in HFrEF patients. In multivariate logistic regression analysis, an increased risk of aortic root dilation was observed in the highest quartile of the PP level compared with the lowest quartile. Age significantly interacted with PP (p = 0.047). A significant association between PP levels and AoD was only observed in patients ≥ 65 years old, but not in patients < 65 years old. In the validation dataset, PP was independently related to AoD in patients with HFrEF (β = 0.205, p = 0.001).
Conclusions:
PP level was independently and positively associated with AoD, especially in the elderly with HFrEF, but not in patients with HFmrEF and HFpEF. Arterial stiffening or vascular aging may play a certain role in the elderly HFrEF patients.
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Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.