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.