Prognostic significance of blood pressure response during vasodilator stress Rb-82 positron emission tomography myocardial perfusion imaging.

Autor: Witbrodt B; Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1462 Clifton Rd., Room 503, Atlanta, GA, 30322, USA. bwitbro@emory.edu., Goyal A; Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1462 Clifton Rd., Room 503, Atlanta, GA, 30322, USA., Kelkar AA; Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1462 Clifton Rd., Room 503, Atlanta, GA, 30322, USA., Dorbala S; Brigham and Women's Hospital, Boston, MA, USA., Chow BJW; Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, USA., Di Carli MF; Brigham and Women's Hospital, Boston, MA, USA., Williams BA; Geisinger Medical Center, Danville, PA, USA., Merhige ME; Niagara Falls Memorial Medical Center, Buffalo, NY, USA., Berman DS; Cedars-Sinai Medical Center, Los Angeles, CA, USA., Germano G; Cedars-Sinai Medical Center, Los Angeles, CA, USA., Beanlands RS; Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, USA., Min JK; Weill Cornell Medical College New York, New York, NY, USA., Arasaratnam P; Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, USA., Sadreddini M; Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, USA., van Velthuijsen ML; Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, USA., Shaw LJ; Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1462 Clifton Rd., Room 503, Atlanta, GA, 30322, USA.
Jazyk: angličtina
Zdroj: Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology [J Nucl Cardiol] 2017 Dec; Vol. 24 (6), pp. 1966-1975. Date of Electronic Publication: 2016 Sep 22.
DOI: 10.1007/s12350-016-0569-1
Abstrakt: Background: A drop in blood pressure (BP) or blunted BP response is an established high-risk marker during exercise myocardial perfusion imaging (MPI); however, data are sparse regarding the prognostic value of BP response in patients undergoing vasodilator stress rubidium-82 (Rb-82) Positron Emission Tomography (PET) MPI.
Methods and Results: From the PET Prognosis Multicenter Registry, a cohort of 3413 patients underwent vasodilator stress Rb-82 PET MPI with dipyridamole or adenosine. We used multivariable Cox proportional hazard regression to analyze the association with mortality of four BP variables: stress minus rest systolic BP (∆SBP), stress minus rest diastolic BP (∆DBP), resting systolic BP (rSBP), and resting diastolic BP (rDBP). Covariates that had univariate P values <.10 were entered into the multivariable model. After median 1.7 years follow-up, 270 patients died. In univariate analyses, ∆SBP (P = .082), rSBP (P = .008), and rDBP (P < .001) were of potential prognostic value (P < .10), but ∆DBP was not (P = .96). After adjustment for other clinical and MPI variables, ∆SBP no longer independently predicted mortality (P = .082); only lower rSBP (P = .026) and lower rDBP (P = .045) remained independently prognostic.
Conclusions: In patients undergoing vasodilator stress MPI, only lower resting BP is an independent predictor of mortality along with other clinical and MPI variables; BP response does not appear to add to risk stratification in these patients.
Databáze: MEDLINE
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