Proportional pulse pressure relates to cardiac index in stabilized acute heart failure patients.

Aims: In chronic heart failure, proportional pulse pressure (PPP) is suggested as an estimate of cardiac index (CI). The association between CI and PPP in acute heart failure (AHF) has not been described. Methods: This was examined using hemodynamic measurements (from a trial using serelaxin) in 63 stabilized AHF patients. Results: Mean (SD) age was 68 (11), 74% male, mean (SD) ejection fraction (EF) was 33.4% (13.7), mean (SD) CI (L/min/m(2)) was 2.3 (0.6). CI correlated with PPP (Pearson R=0.42; p<0.0001) based on a linear mixed-effects model analysis of 171 pairs of measurements from 47 patients (out of 63) where CI and PPP were measured within 3min of each other during. Serelaxin treatment did not modify the established correlation between CI and PPP. Time-weighted average CI correlated with time-weighted average PPP (Spearman Rank R=0.35; p=0.0051) over the -4h to 24h time interval. In a multivariable regression analysis, low PPP was an independent predictor of low CI (p<0.0001). Conclusions: In patients with AHF after initial clinical stabilization, both baseline and post-baseline CI measurements are positively related to PPP. This was the most closely related non-invasive blood pressure variable to CI.