RT Journal Article
SR Electronic
T1 Long-term Follow-up in Hypertensive Patients With Normal Stress Myocardial Perfusion Imaging: a Parametric Analysis
JF Journal of Nuclear Medicine
JO J Nucl Med
FD Society of Nuclear Medicine
SP 1685
OP 1685
VO 57
IS supplement 2
A1 Carmela Nappi
A1 Wanda Acampa
A1 Emilia Zampella
A1 Roberta Assante
A1 Valeria Gaudieri
A1 Teresa Mannarino
A1 Roberta Green
A1 Valeria Cantoni
A1 Mario Petretta
A1 Alberto Cuocolo
YR 2016
UL http://jnm.snmjournals.org/content/57/supplement_2/1685.abstract
AB 1685Objectives We assessed the relationship between arterial hypertension and temporal characteristics of cardiac risk at long-term follow-up in hypertensive patients with a normal stress myocardial perfusion single-photon emission computed tomography (MPS).Methods We evaluated 471 consecutive hypertensive patients without known coronary artery disease (CAD) and normal perfusion at stress MPS. All patients were followed for a mean 76?21 months. End-point events were cardiac death or nonfatal myocardial infarction. The univariable and multivariable associations with cardiac events were determined by Cox proportional hazards regression analysis. A parametric survival model was used to identify how the variables influenced time to event and to estimate the risk-adjusted event rates during the follow-up.Results Of the overall population, 299 (63%) patients underwent exercise stress test and 172 (37%) patients pharmacologic stress test with dipyridamole. At Cox analysis, age (hazard ratio 1.1, P<0.005) and stress test type (hazard ratio 2.7, P<0.005) were independent predictors of cardiac events. In patients undergoing exercise stress test, peak systolic arterial pressure (PAS) (hazard ratio 1.1, P<0.005) resulted as predictor of cardiac events. At parametric analysis, patients <60 years old who performed exercise stress test remained at low risk for the entire length of follow-up, while the highest probability of events and the major risk acceleration was observed in patients >60 years old who underwent pharmacologic stress test. In the 299 patients undergoing exercise stress test, only those who reached PAS <160 mmHg remained at low risk for the entire length of follow-up. In contrast, time to achieve a cumulative cardiac risk level of 3% was 49 months in the presence of PAS 160-180 mmHg, 35 months for PAS 180-200 and only 10 months for PAS >200 mmHg.Conclusions In hypertensive patients without known CAD, a normal stress MPS should be considered reassuring in subjects <60 years old who performed exercise stress test and in those who reached a peak PAS <160 mmHg independently on age. On the other hand, patients who underwent exercise stress test and reached peak PAS >200 and those submitted to pharmacologic stress test should be considered for a more aggressive management.