Cardiovascular Journal of Africa • SAHS Biennial Congress 2024 13 AFRICA Submission ID: 1631 Introduction In patients with systolic heart failure (HF), both decreases and increases in pulse pressure (PP) are associated with poor prognosis. If aortic PP in systolic HF is decreased due to systolic dysfunction, then improvements in stroke volume (SV) or forward wave pressure (Pf) would be beneficial. Alternatively, if hypertension is the primary cause of systolic HF, aortic PP may be increased due to high aortic characteristic impedance (Zc) and backward wave pressure (Pb), which would be detrimental. I aimed to compare central aortic hemodynamics, and the impact of BP control, between stable systolic HF patients and community participants. Methods Consecutive consenting adult patients diagnosed with HF of systolic origin (n=42), were randomly recruited from the hypertension clinic at Life Flora Hospital, Johannesburg. Central aortic pressure (SphygmoCor) and aortic outflow tract diameter and flow velocity (echocardiography) were acquired for each patient. The aortic pressure waves were coupled with the aortic flow waves, and wave separation analysis was performed to obtain the various determinants of PPc (backward wave pressure [Pb], forward wave pressure [Pf], reflected pressure, rereflected pressure, aortic flow [Q], aortic characteristic impedance [Zc], the pressure generated by the product of flow and characteristic impedance [QxZc]). Stroke volume (SV) and systemic vascular resistance (SVR) were calculated using standard formulae. The data collected from the 42 stable HF patients, was compared to data collected in 298 age- and sex-matched participants from a community-based study, adjusting for potential confounders that may differ between these two groups. The impact of BP control (SBP/DBP<140/90mmHg), and more intense BP control (SBP/DBP<30/80 mm Hg), on comparisons of haemodynamic variables between patients with systolic HF and community participants, was assessed using multivariate-adjusted ANOVA. Results Systolic HF patients had lower central PP and Pb (p<0.005) and higher HR (p<0.005) than community participants. No other differences were noted. Systolic HF patients with uncontrolled BP (SBP/DBP≥140/90mmHg) had higher Zc (p<0.005), Pf (p<0.05), and SVR (p<0.05) than both HF patients and community participants with controlled BP. Despite similar peripheral and central PP to community participants with uncontrolled BP, Zc (p<0.005) and SVR (p<0.05) were higher in HF patients with uncontrolled BP. However, when assessing more intense BP control (SBP/DBP<130/80mmHg), the differences in Zc, QxZc, and SVR between the HF patients and community participants with uncontrolled BP were eliminated. Conclusion A lower central aortic PP, which was not due to decreased SV, was observed in stable systolic HF patients. However, in the presence of uncontrolled BP (SBP/DBP≥140/90mmHg), but not intense BP control (SBP/DBP<130/80mmHg), Zc, QxZc and SVR were increased in patients with systolic HF. Hence, BP control and its level of control are imperative in patients with systolic HF to protect the heart from the detrimental effects of increased afterloads. Name: Presenting Author Information Article Category Abstract Title Marcus N Lebelo, Vernice R Peterson, Danelle Els, Jamie-Leigh Kinsey, Ferande Peters, Angela J Woodiwiss. 1607905@students.wits.ac.za English Abstract Students - Currently enrolled postgraduate students Comparison of Aortic Haemodynamics in Community Participants and Patients with Systolic Heart Failure and the Impact of Blood Pressure Control. Author Affiliation: Email: Marcus N Lebelo Science Theme Clinical Author Name & Surname Title Expertise Affiliation Email Country Marcus Lebelo Mr CPGRU 1607905@students.wits.ac.za South Africa ORAL PRESENTATION
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