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Pulse pressure and aortic valve peak velocity and incident heart failure after myocardial infarction: a cohort study

Yuzhong Wu1,2, Jingjing Zhao1,2, Chen Chen1,2

  • 1Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.

Heart (British Cardiac Society)
|February 6, 2025
PubMed

Insights

Pulse pressure and aortic valve peak velocity predict heart failure with preserved ejection fraction in myocardial infarction patients. These markers aid early risk stratification and intervention for better outcomes.

Area of Science:

  • Cardiology
  • Cardiovascular Medicine
  • Clinical Research

Background:

  • Heart failure with preserved ejection fraction (HFpEF) is a recognized outcome post-myocardial infarction (MI), though less common than heart failure with reduced ejection fraction.
  • Early identification of HFpEF predictors in MI patients is crucial for developing targeted preventive strategies.
  • This study investigates pulse pressure and aortic valve peak velocity as potential early indicators of HFpEF following MI.

Purpose of the Study:

  • To determine if pulse pressure and aortic valve peak velocity can serve as early predictors of heart failure with preserved ejection fraction (HFpEF) in patients with a history of myocardial infarction (MI).
  • To assess the association between these hemodynamic parameters and the risk of developing HFpEF after MI.

Main Methods:

  • Retrospective analysis of 5188 participants from the Atherosclerosis Risk in Communities Study, including 802 with a history of MI and no prior heart failure.
  • Heart failure events were categorized into HFpEF (left ventricular ejection fraction ≥50%) and heart failure with mildly reduced or reduced ejection fraction (LVEF <50%).
  • Competing risk regression models were employed to analyze the relationship between baseline pulse pressure, aortic valve peak velocity, and HFpEF development.

Main Results:

  • Over a 6-year follow-up, higher pulse pressure and aortic valve peak velocity were significantly associated with an increased risk of HFpEF in MI patients.
  • Specifically, a 1-SD increase in pulse pressure correlated with a 1.60-fold higher risk of HFpEF, while aortic valve peak velocity showed a 1.37-fold higher risk.
  • Patients with elevated pulse pressure (≥68 mmHg) or aortic valve peak velocity (≥1.4 m/s) exhibited substantially higher risks of HFpEF. The presence of two or more risk factors (elevated pulse pressure, elevated aortic valve peak velocity, diabetes, atrial fibrillation) increased HFpEF risk over 16-fold.

Conclusions:

  • Pulse pressure and aortic valve peak velocity are significant early predictors of heart failure with preserved ejection fraction in patients following myocardial infarction.
  • These findings support their utility in early risk stratification for HFpEF in the MI population.
  • The results advocate for incorporating these markers into clinical practice to guide timely interventions and prevent HFpEF progression.
Abstract

Keywords:
Cohort StudiesHeart Failure, DiastolicHeart failureMyocardial InfarctionRisk Factors

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