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ORIGINAL RESEARCH ARTICLE
Proportional pulse pressure as a non-invasive predictor of cardiac index in heart failure with reduced ejection fraction: A pilot study
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1 Department of Cardiology, Mardin Training and Research Hospital, Mardin,
Turkey
2 Department of Cardiology, Gazi Yasargil Training and Research Hospital, University of Health Sciences, Diyarbakır,
Turkey
3 Department of Cardiology, Faculty of Medicine, Necmettin Erbakan University, Konya,
Turkey
Brain & Heart, 026100015 https://doi.org/10.36922/BH026100015
Received: 8 March 2026 | Revised: 22 May 2026 | Accepted: 29 May 2026 | Published online: 2 July 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
Abstract
The primary objective of this pilot study is to examine the correlation between proportional pulse pressure (PPP) and cardiac index (CI) in patients with reduced ejection fraction (HFrEF) heart failure, and to assess the usability of PPP as a non-invasive, practical biomarker for predicting hemodynamic profiles. We enrolled 100 patients with HFrEF (EF ≤ 40%) from our cardiology clinic. Blood pressure was measured manually using a mercury sphygmomanometer, and CI was assessed via transthoracic echocardiography. Patients were stratified by CI (<2.2 L/min/m2 vs. ≥2.2 L/min/m2), and PPP was calculated as pulse pressure divided by systolic blood pressure. The mean age was 67 years (77% male). PPP values were significantly diminished among patients with low CI (p < 0.001), while correlation analysis indicated a strong positive relationship between PPP and CI (r = 0.584, p < 0.001). A PPP threshold of ≥25.85% identified CI ≥ 2.2 L/min/m2 with 84% sensitivity and 89.2% specificity.PPP, readily derived from routine blood pressure measurements, strongly correlates with CI in patients with HFrEF. It can serve as a non-invasive hemodynamic assessment modality in primary care settings or healthcare facilities with limited resources where echocardiography is unavailable.
Keywords
Pulse pressure
Heart failure
Proportional pulse pressure
Cardiac index
Funding
None.
Conflict of interest
The authors declare no competing interests.
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