Association of proportional pulse pressure with cardiac function and complications in patients hospitalized with acute exacerbation of chronic heart failure

Proportional pulse pressure (PPP), calculated as pulse pressure divided by systolic blood pressure, is a simple, non-invasive hemodynamic index. Previous studies suggest its potential role in assessing cardiac function and prognosis in heart failure (HF) patients, particularly in identifying low cardiac output. This study aimed to investigate the relationship between PPP and key cardiac functional indices (Cardiac Index [CI] and Cardiac Output [CO]) in patients with hospitalized with acute exacerbation of chronic heart failure (CHF). This cross-sectional study included 80 hospitalized patients with acute exacerbation of CHF at Baqiyatallah Hospital in Tehran (2024). Patients with arrhythmias (including atrial fibrillation, atrial flutter, or ventricular tachycardia), valvular disease, or thyroid disorders were excluded. Brachial blood pressure was measured multiple times, and average PPP was calculated. CI and CO were determined via transthoracic echocardiography. Correlation and multiple regression analyses were performed to assess the relationship between PPP and CI/CO, controlling for confounders like age and gender. Patients were also divided into quartiles based on PPP for comparative analysis. The mean age was 64.8 ± 10.7 years, and 70% were male. A modest but statistically significant positive correlation was found between PPP and both CI ( r = 0.258, p = 0.021) and CO ( r = 0.187, p = 0.04). Multivariate regression identified PPP as the strongest independent predictor for both CO (Beta = 0.324, p = 0.009) and CI (Beta = 0.324, p = 0.007). Patients in the lowest PPP quartile had significantly lower CO (2.6 vs. 7.0 L/min, p < 0.0001), lower LVOT-VTI (10.6 vs. 21.2 cm), higher heart rate in the highest PPP quartile (89.6 vs. 74.3 bpm in Q2, p = 0.04), and a similar prevalence of pleural effusion (55% vs. 55%, p = 0.9) compared to the highest quartile. Trends towards lower ejection fraction and inverse correlations with BNP and QT interval were not statistically significant. This study found that proportional pulse pressure is associated with key haemodynamic parameters in patients hospitalised for an acute exacerbation of chronic heart failure. A modest positive correlation was observed between PPP and both cardiac index and cardiac output, and PPP emerged as an independent predictor in the multivariate regression analysis. However, larger prospective multicentre studies are needed to validate these findings.