Glucose-potassium ratio and pulmonary capillary wedge pressure as complementary prognostic markers in ischemic heart failure with preserved ejection fraction
DOI:
https://doi.org/10.14739/2310-1237.2026.1.349402Keywords:
HFpEF, glucose-potassium ratio, pulmonary capillary wedge pressure, cardiorenalAbstract
Heart failure with preserved ejection fraction (HFpEF) is a complex syndrome characterized by multi-organ involvement, systemic inflammation, and metabolic dysregulation. Pulmonary capillary wedge pressure (PCWP) reflects hemodynamic congestion, while the glucose-potassium ratio (GPR) has emerged as a non-invasive marker of renal tubular dysfunction and metabolic stress. The prognostic value of GPR, alone and in combination with PCWP, remains underexplored in patients with ischemic HFpEF.
Aim. To investigate the independent and complementary prognostic significance of the glucose-potassium ratio (GPR) and pulmonary capillary wedge pressure (PCWP) in predicting 5-year adverse outcomes in patients with ischemic HFpEF.
Materials and methods. Eighty-eight patients with ischemic HFpEF (NYHA functional class II–IV, stage II A–B; 41 men, 47 women; 59 with sinus rhythm and 29 with atrial fibrillation) were prospectively followed for 5 years. Baseline PCWP was estimated non-invasively using transthoracic echocardiography according to ESC/ASE recommendations, with the formula: PCWP (mmHg) = 1.24 × (E / e’) + 1.9, where E is the early mitral inflow velocity and e’ is the early diastolic mitral annular velocity. GPR was calculated from serum glucose and potassium. Receiver operating characteristic (ROC) analysis identified optimal cut-offs (GPR >1.18, PCWP >14.16 mmHg). Univariate and multivariate logistic regression models assessed the association with the composite endpoint of heart failure hospitalization or cardiovascular death/
Results. During follow-up, 9 patients (10.2 %) reached the composite endpoint. In univariate analysis, GPR >1.18 and PCWP >14.16 mmHg predicted adverse events (OR 11.15, p = 0.0048; OR 8.52, p = 0.0044, respectively). Serum glucose and potassium levels considered separately were not associated with outcomes. In multivariate analysis, both GPR (OR 9.79, p = 0.039) and PCWP (OR 7.51, p = 0.019) remained independent predictors. The combined model demonstrated high discriminative ability (AUC 0.837, p = 0.0007), indicating complementary but non-overlapping prognostic information.
Conclusions. In ischemic HFpEF, GPR and PCWP are robust, independent predictors of long-term adverse outcomes. GPR serves as a practical non-invasive surrogate of hemodynamic stress, offering prognostic insight comparable to invasive measurement. Their combined assessment may enhance risk stratification and guide personalized management strategies.
References
- Matthews E. Heart Failure with Preserved Ejection Fraction. Am J Nurs. 2025;125(11):28-32. doi: https://doi.org/10.1097/AJN.0000000000000184
| 
| 
- Shafeghat M, Raza Y, Catania R, Rahsepar AA, Tilkens B, Cuttica MJ, et al. State of the Art in Pulmonary Arterial Hypertension: Molecular Basis, Imaging Modalities, and Right Heart Failure Treatment. Biomedicines. 2025;13(7):1773. doi: https://doi.org/10.3390/biomedicines13071773
| | - Rosano G, Teerlink JR, Kinugawa K, Bayes-Genis A, Chioncel O, Fang J, et al. The use of left ventricular ejection fraction in the diagnosis and management of heart failure. A clinical consensus statement of the Heart Failure Association (HFA) of the ESC, the Heart Failure Society of America (HFSA), and the Japanese Heart Failure Society (JHFS). Eur J Heart Fail. 2025;27(7):1174-87. doi: https://doi.org/10.1002/ejhf.3646
| | - van Dalen BM, Chin JF, Motiram PA, Hendrix A, Emans ME, Brugts JJ, et al. Challenges in the diagnosis of heart failure with preserved ejection fraction in individuals with obesity. Cardiovasc Diabetol. 2025;24(1):71. doi: https://doi.org/10.1186/s12933-025-02612-z
| | - Bayes-Genis A, Pagnesi M, Codina P, Abraham WT, Amir O, de Boer RA, et al. Remote pulmonary artery pressure-guided management of patients with heart failure: A clinical consensus statement of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2025;27(9):1644-1657. doi: https://doi.org/10.1002/ejhf.3619
| | - Kapelios CJ, Liori S, Bonios M, Abraham WT, Filippatos G. Effect of pulmonary artery pressure-guided management on outcomes of patients with heart failure outside clinical trials: A systematic review and meta-analysis of real-world evidence with the CardioMEMS Heart Failure System. Eur J Heart Fail. 2025;27(10):1857-65. doi: https://doi.org/10.1002/ejhf.3687
| | - Tran N, Shaar M, Al-Sudani H, Sedhom R, Akhtar H, Lo KB, et al. Comparative Value of Echocardiography vs. Right Heart Catheterization in Heart Failure With Preserved Ejection Fraction. Echocardiography. 2025;42(12):e70362. doi: https://doi.org/10.1111/echo.70362
| | - Salah HM, Alexy T, Tedford RJ, Hiivala NJ, Owens MM, Klein L, et al. Comparison of supine and sitting pulmonary pressures in ambulatory heart failure patients using the novel Cordella pulmonary pressure system. ESC Heart Fail. 2025;12(5):3399-404. doi: https://doi.org/10.1002/ehf2.15374
| | - Yildiz G, Hur E, Magden K, Candan F, Kayatas M, Yildirim İ, et al. A new technique for the detection of dry weight in hemodialysis patients: Estimated pulmonary capillary wedge pressure. A tissue Doppler imaging study. Nefrologia (Engl Ed). 2022;42(4):471-80. doi: https://doi.org/10.1016/j.nefroe.2021.04.008
| | - Syvolap VV, Lysenko VA. The glucose-potassium ratio as a marker of adverse prognosis in patients with chronic heart failure. Zaporozhye Medical Journal. 2025;27(1):13-9. doi: https://doi.org/10.14739/2310-1210.2025.1.320864
| - Lo KB, Janakiraman A, Rangaswami J. Kidney Dysfunction in Heart Failure: Core Curriculum 2025. Am J Kidney Dis. 2025;86(1):109-24. doi: https://doi.org/10.1053/j.ajkd.2024.12.006
| | - Lysenko VA, Syvolap VV. [Association of early prognosis in patients with chronic heart failure with markers of renal tubulointerstitial dysfunction]. Modern Medical Technology. 2025;17(1):5-11. Ukrainian. doi: https://doi.org/10.14739/mmt.2025.1.321809
| - Klein L, Fudim M, Etemadi M, Gordon R, Tibrewala A, Hernandez-Montfort J, et al. Noninvasive Pulmonary Capillary Wedge Pressure Estimation in Heart Failure Patients With the Use of Wearable Sensing and AI. JACC Heart Fail. 2025;13(8):102513. doi: https://doi.org/10.1016/j.jchf.2025.102513
| | - Bazan L, Gentile F, Sciarrone P, Buoncristiani F, Panichella G, Gasparini S, et al. Echocardiographic Estimate of Pulmonary Capillary Wedge Pressure Improves Outcome Prediction in Heart Failure Patients With Reduced and Mildly Reduced Ejection Fraction. J Am Soc Echocardiogr. 2025;38(7):586-98. doi: https://doi.org/10.1016/j.echo.2025.04.005
| | - Younis A, Tabi M, Kashani KB, Dahiya G, Jokhadar M, Hillerson DB, et al. Echocardiographic Correlates of Hyponatremia in Critically Ill Patients With Heart Failure. Int J Heart Fail. 2025;7(4):243-53. doi: https://doi.org/10.36628/ijhf.2025.0057
| | - Durrani O, Saeed S, Kanwel S, Khaliq M, Farrukh A. Evaluating Hyponatremia as a Predictor of Mortality in Heart Failure Patients in a Tertiary Healthcare Setting. Cureus. 2025;17(11):e96048. doi: https://doi.org/10.7759/cureus.96048
| - McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2023;44(37):3627-39. doi: https://doi.org/10.1093/eurheartj/ehad195
| | - Voronkov LG, Amosova KM, Dziak GV, Zharinov OJ, Kovalenko VM, Korkushko OV, et al. [Guidelines of the Ukraine Association of Cardiology for the Diagnosis and Treatment of Chronic Heart Failure (2017)]. Ukrainian Journal of Cardiology. 2018;25(3):11-59. Ukrainian. Available from: https://ucardioj.com.ua/index.php/UJC/article/view/39
- Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015;16(3):233-70. doi: https://doi.org/10.1093/ehjci/jev014
| | - Grapsa J, Argulian E, Smiseth OA. Diastolic dysfunction: a comparison of 2025 ASE, 2024 BSE and 2022 EACVI guidelines. Eur Heart J Cardiovasc Imaging. 2025;26(11):1725-7. doi: https://doi.org/10.1093/ehjci/jeaf269
| | - Kahraman E, Keles N, Parsova KE, Bastopcu M, Karatas M. Echocardiographic assessment of pulmonary capillary wedge pressure in patients with frequent premature ventricular complexes. Echocardiography. 2023;40(6):531-6. doi: https://doi.org/10.1111/echo.15590
| |
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Copyright (c) 2026 V. A. Lysenko, V. V. Syvolap, L. L. Vorontsova
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