Abstract
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Objectives: Hypertension is a major risk factor for coronary artery disease (CAD) and its association with other risk factors increases the risk of cardiac death. Identification of these high risk patients (pts) is important for the selection of optimal management. The aim of the study was to identify which asymptomatic hypertensive (H) pts are best candidates for screening for silent CAD with TC99m Sestamibi SPECT myocardial perfusion imaging (MPI).
Methods: 1060 asymptomatic hypertensives > 44 years were selected according to the criteria defined by the American Diabetes Association (ADA). All pts underwent dipyridamole stress and rest MPI. We prospectively investigated the association between a number of clinical and laboratory variables and abnormal summed stress score (SSS).
Results: The population included 619 hypertensives and 441 hypertensives with type 2 diabetes mellitus (DM). An abnormal SSS was present in 310 H pts (29.2%). Multivariate analysis demonstrated that six variables were independently associated with abnormal SSS: albuminuria (OR : 2.49; 95% CI: 1.6-4.0; P ≤ 0.0001), male gender (OR : 2.29; 95% CI: 1.7-3.0; P ≤ 0.0001), type 2 diabetes mellitus (DM) (OR: 1.78; 95% CI: 1.4-2.3; P ≤ 0.0001), abnormal ECG (OR: 1.64; 95% CI: 1.2-2.1; P ≤ 0.0001), dyslipidemia (OR: 1.41; 95% CI: 1.1-1.9; P ≤ 0.01), and peripheral artery disease (OR: 1.41; 95% CI: 1.1-1.8; P ≤ 0.01). Subgroup analysis showed that albuminuria represented the best predictor in type 2 diabetic hypertensive pts (n=441) where an abnormal MPI was found in 50% of patients in this category.
Conclusions: This prospective study using dipyridamole stress TC99m sestamibi SPECT in a large sample size of asymptomatic hypertensive pts representative of the daily clinical practice, showed that DM with albuminuria represents the most powerful predictor for an abnormal MPI compare to other traditional known risk factors when screening for silent CAD.
- Society of Nuclear Medicine, Inc.