Prognostic value of daytime heart rate, blood pressure, their products and quotients in chronic heart failure.

BACKGROUND: Chronic heart failure (CHF) is an important epidemiological and therapeuthic issue with poor prognosis. The aim of the study was to estimate the prognostic value of daytime heart rate (HR), blood pressure (BP), their products and quotients in patients with CHF.

METHODS: The study included 80 stable patients with CHF and reduced left ventricular ejection fraction (LVEF ≤ 35%). Physical examination, laboratory blood tests, electrocardiogram, chest X-ray, echocardiography, 6-minute walk test (6MWT), telemetry monitoring and BP measurements were performed in all participants. We estimated mean daytime: BP, HR, their products and quotients. The follow-up period was 6 months. Major adverse cardiac events (MACE) included: death, cardiovascular death, hospitalization due to CHF exacerbation.

RESULTS: The analysis involved all recruited patients with CHF (91% men) aged 59 ± 12 years, in New York Heart Association class 2.15 ± 0.57 and reduced LVEF (mean LVEF: 23 ± 6%). The 3-month and 6-month mortality rates were 4% and 6% respectively. There was a significant correlation between diastolic blood pressure (DBP), all-cause mortality (p = 0.048) and CHF decompensation (p = 0.0004) after 3-month observation period. No relationship was found between HR or systolic blood pressure (SBP) and MACE. Both higher SBP × HR and DBP × HR products were related to lower risk of heart failure exacerbations during 6-month follow-up. None of the analyzed products or ratios had an impact on mortality in this study group.

CONCLUSIONS: Diastolic blood pressure, SBP × HR and DBP × HR products may be useful in subsequent heart failure exacerbation risk stratification. Moreover, DBP value may predict short-term mortality in patients with CHF.