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.

Prognostic value of coronary vascular dysfunction assessed by rubidium-82 PET/CT imaging in patients with resistant hypertension without overt coronary artery disease / Gaudieri, Valeria; Mannarino, Teresa; Zampella, Emilia; Assante, Roberta; D'Antonio, Adriana; Nappi, Carmela; Cantoni, Valeria; Green, Roberta; Petretta, Mario; Arumugam, Parthiban; Cuocolo, Alberto; Acampa, Wanda. - In: EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING. - ISSN 1619-7089. - 48:(2021), pp. 3162-3171. [10.1007/s00259-021-05239-w]

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

Gaudieri, Valeria;Mannarino, Teresa;Zampella, Emilia;Assante, Roberta;D'Antonio, Adriana;Nappi, Carmela;Cantoni, Valeria;Green, Roberta;Petretta, Mario;Cuocolo, Alberto;Acampa, Wanda
2021

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.
2021
Prognostic value of coronary vascular dysfunction assessed by rubidium-82 PET/CT imaging in patients with resistant hypertension without overt coronary artery disease / Gaudieri, Valeria; Mannarino, Teresa; Zampella, Emilia; Assante, Roberta; D'Antonio, Adriana; Nappi, Carmela; Cantoni, Valeria; Green, Roberta; Petretta, Mario; Arumugam, Parthiban; Cuocolo, Alberto; Acampa, Wanda. - In: EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING. - ISSN 1619-7089. - 48:(2021), pp. 3162-3171. [10.1007/s00259-021-05239-w]
File in questo prodotto:
File Dimensione Formato  
Gaudieri et al. EJNMMI (2021).pdf

accesso aperto

Descrizione: Articolo su rivista
Tipologia: Versione Editoriale (PDF)
Licenza: Dominio pubblico
Dimensione 517.34 kB
Formato Adobe PDF
517.34 kB Adobe PDF Visualizza/Apri

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11588/838440
Citazioni
  • ???jsp.display-item.citation.pmc??? ND
  • Scopus 15
  • ???jsp.display-item.citation.isi??? 13
social impact