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. 2021 Sep;48(10):3162-3171.
doi: 10.1007/s00259-021-05239-w. Epub 2021 Feb 16.

Prognostic value of coronary vascular dysfunction assessed by rubidium-82 PET/CT imaging in patients with resistant hypertension without overt coronary artery disease

Valeria Gaudieri  1 , Teresa Mannarino  1 , Emilia Zampella  1 , Roberta Assante  1 , Adriana D'Antonio  1 , Carmela Nappi  1 , Valeria Cantoni  1 , Roberta Green  1 , Mario Petretta  2 , Parthiban Arumugam  3 , Alberto Cuocolo  1 , Wanda Acampa  4   5
Affiliations

Prognostic value of coronary vascular dysfunction assessed by rubidium-82 PET/CT imaging in patients with resistant hypertension without overt coronary artery disease

Valeria Gaudieri et al. Eur J Nucl Med Mol Imaging. 2021 Sep.

Abstract

Purpose: The identification of coronary vascular dysfunction may enhance risk stratification in patients with resistant hypertension (RH). We evaluated if impaired coronary vascular function, assessed by rubidium-82 (82Rb) positron emission tomography/computed tomography (PET/CT) imaging, is associated with increased cardiovascular risk in patients with hypertension without overt coronary artery disease (CAD).

Methods: We studied 517 hypertensive subjects, 26% with RH, without overt CAD, and with normal stress-rest myocardial perfusion imaging at 82Rb PET/CT. The outcome end points were cardiac death, nonfatal myocardial infarction, coronary revascularization, and admission for heart failure.

Results: Over a median of 38 months (interquartile range 26 to 50), 21 cardiac events (4.1% cumulative event rate) occurred. Patients with RH were older (p < 0.05) and had a higher prevalence of left ventricular hypertrophy (p < 0.001), a lower hyperemic myocardial blood flow (MBF), and myocardial perfusion reserve (MPR) (both p < 0.001) compared to those without. Conversely, coronary artery calcium content and baseline MBF were not different between patients with and without RH. At univariable Cox regression analysis, age, RH, left ventricular ejection fraction, coronary artery calcium score, and reduced MPR were significant predictors of events. At multivariable analysis, age, RH, and reduced MPR (all p < 0.05) were independent predictors of events. Patients with RH and reduced MPR had the highest risk of events and the major risk acceleration over time.

Conclusion: The findings suggest that the assessment of coronary vascular function may enhance risk stratification in patients with hypertension.

Keywords: Myocardial perfusion reserve; PET/CT; Prognosis; Resistant hypertension.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Event-free survival curves by Kaplan-Meyer analysis (a) and annualized event rates (b) according to hypertensive and coronary vascular function status. CH, controlled hypertension; RH, resistant hypertension; MPR, myocardial perfusion reserve
Fig. 2
Fig. 2
Predicted cumulative hazard by hypertension and coronary vascular function (a) and median survival time by age, hypertension, and coronary vascular function (b). Abbreviations as in Fig. 1
See this image and copyright information in PMC

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References

    1. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, ESC Scientific sDocument Group et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021–3104. doi: 10.1093/eurheartj/ehy339. - DOI - PubMed
    1. Carey RM, Calhoun D, Bakris G, Brook RD, Daugherty SL, Dennison-Himmelfarb CR, American Heart Association Professional/Public Education and Publications Committee of the Council on Hypertension; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Genomic and Precision Medicine; Council on Peripheral Vascular Disease; Council on Quality of Care and Outcomes Research; and Stroke Council et al. Resistant hypertension: detection, evaluation, and management: a scientific statement from the American Heart Association. Hypertension. 2018;72(5):e53–e90. doi: 10.1161/HYP.0000000000000084. - DOI - PMC - PubMed
    1. Prior JO, Allenbach G, Valenta I, Kosinski M, Burger C, Verdun FR, et al. Quantification of myocardial blood flow with 82Rb positron emission tomography: clinical validation with 15O-water. Eur J Nucl Med Mol Imaging. 2012;39(6):1037–1047. doi: 10.1007/s00259-012-2082-3. - DOI - PMC - PubMed
    1. Zampella E, Acampa W, Assante R, Nappi C, Gaudieri V, Mainolfi CG, et al. Combined evaluation of regional coronary artery calcium and myocardial perfusion by (82)Rb PET/CT in the identification of obstructive coronary artery disease. Eur J Nucl Med Mol Imaging. 2018;45(4):521–529. doi: 10.1007/s00259-018-3935-1. - DOI - PubMed
    1. Schindler TH, Schelbert HR, Quercioli A, Dilsizian V. Cardiac PET imaging for the detection and monitoring of coronary artery disease and microvascular health. JACC Cardiovasc Imaging. 2010;3(6):623–640. doi: 10.1016/j.jcmg.2010.04.007. - DOI - PubMed

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