Abstract
PurposeThe 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).MethodsWe 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.ResultsOver 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.ConclusionThe findings suggest that the assessment of coronary vascular function may enhance risk stratification in patients with hypertension.
Highlights
This article is part of the Topical Collection on CardiologyTrust, Manchester, UK 4 Institute of Biostructure and Bioimaging, National Council of Research, Naples, ItalyHypertension is the leading risk factor for stroke, cardiovascular disease, and premature death [1]
Previous studies demonstrated that patients with resistant hypertension (RH) compared with patients with controlled hypertension (CH) have a lower value of coronary flow reserve assessed by transthoracic Doppler echocardiography [9] and lower hyperemic myocardial blood flow (MBF) and myocardial perfusion reserve (MPR) evaluated by 82Rb positron emission tomography/ computed tomography (PET/computed tomography (CT)) [10]
This study was designed to evaluate whether measurement of coronary vascular function by 82Rb positron emission tomography (PET)/CT helps in predicting outcome in patients with hypertension and without overt coronary artery disease (CAD)
Summary
The added value of MBF and MPR has been demonstrated in the identification of impaired coronary vascular function and as an indicator of therapeutic interventions effectiveness [5] and in the prognostic assessment of the patient with suspected and known coronary artery disease (CAD) [6,7,8]. Previous studies demonstrated that patients with RH compared with patients with CH have a lower value of coronary flow reserve assessed by transthoracic Doppler echocardiography [9] and lower hyperemic MBF and MPR evaluated by 82Rb PET/CT [10]. This study was designed to evaluate whether measurement of coronary vascular function by 82Rb PET/CT helps in predicting outcome in patients with hypertension and without overt CAD
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