Key result
Reduced myocardial perfusion reserve independently predicted adverse cardiac events (HR 2.58) in hypertensive patients without overt coronary artery disease, especially those with resistant hypertension.
Why the study?
It was unclear whether impaired coronary vascular function assessed by 82Rb PET/CT imaging is associated with increased cardiovascular risk in hypertensive patients without overt CAD.
Does coronary vascular dysfunction assessed by rubidium-82 PET/CT imaging predict cardiovascular events in hypertensive patients without overt coronary artery disease?
Cohort (n=517)
No
Does coronary vascular dysfunction assessed by rubidium-82 PET/CT imaging predict cardiovascular events in hypertensive patients without overt coronary artery disease?
Hazard Ratio: 2.58 (95% CI 1–6.61)
p-value: p=<0.05
Impaired coronary vascular function assessed by rubidium-82 PET/CT is an independent predictor of adverse cardiovascular events in hypertensive patients without overt CAD, particularly those with resistant hypertension.
Supports risk stratification via coronary PET in resistant hypertension; leaves open whether targeting dysfunction improves outcomes.
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 ( 82 Rb) 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 82 Rb 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.
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Gaudieri et al. (2021) conducted a cohort in Hypertension without overt coronary artery disease (n=517). Reduced myocardial perfusion reserve (MPR < 2) vs. Normal myocardial perfusion reserve (MPR ≥ 2) was evaluated on Composite of cardiac death, nonfatal myocardial infarction, coronary revascularization, or admission for heart failure (HR 2.58, 95% CI 1.00-6.61, p=<0.05). Reduced myocardial perfusion reserve independently predicted adverse cardiac events (HR 2.58) in hypertensive patients without overt coronary artery disease, especially those with resistant hypertension.
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