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

Bradley Witbrodt, Abhinav Goyal, Anita A. Kelkar, Sharmila Dorbala, Benjamin J.W. Chow, Marcelo F. Di Carli, Brent A. Williams, Michael E. Merhige, Daniel S. Berman, Guido Germano, Robert S. Beanlands, James K. Min, Punitha Arasaratnam, Masoud Sadreddini, Marjolein Lidwine van Velthuijsen, Leslee J. Shaw

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)1966-1975
Number of pages10
JournalJournal of Nuclear Cardiology
Volume24
Issue number6
DOIs
StatePublished - 1 Dec 2017
Externally publishedYes

Keywords

  • Blood pressure response
  • myocardial perfusion imaging (MPI)
  • positron emission tomography (PET)
  • prognosis
  • vasodilator stress

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