Key result
In high-risk hypertensive patients, peak end-systolic volume was a strong independent predictor of cardiac death and acute coronary syndrome (HR 3.62), significantly improving risk stratification when combined with perfusion assessment.
Why the study?
Does combined assessment of left ventricular perfusion and function by gated SPECT predict adverse outcomes in hypertensive patients?
Cohort (n=415)
Does combined assessment of left ventricular perfusion and function by gated SPECT predict adverse outcomes in hypertensive patients?
Hazard Ratio: 3.62 (95% CI 1.35–9.69)
p-value: p=<0.05
Combined assessment of left ventricular perfusion and function by gated SPECT significantly improves risk stratification for death and acute coronary syndrome in hypertensive patients.
May support gated SPECT risk stratification in high-risk hypertension; hypothesis-generating and should not yet change practice.
OBJECTIVE: This study was aimed at verifying whether combined information on left ventricular perfusion and function by electrocardiogram-gated single-photon emission computed tomography (SPECT) retains its known prognostic value in patients with systemic hypertension. METHODS: A total of 415 hypertensive patients underwent rest and stress (exercise in 278 and dipyridamole in 137) gated 99mTc-sestamibi SPECT and prospective follow-up for the composite endpoint of death and acute coronary syndrome. Patients undergoing revascularization were censored. The individual effect of clinical and stress imaging data on outcome was evaluated by Cox regression analysis. Model validation was performed using bootstrap methods adjusted by the degree of optimism in estimates. Survival analysis was performed using the product-limit Kaplan-Meier method. RESULTS: During a median follow-up of 24 months, 12 cardiac deaths and 32 acute coronary syndromes occurred. After adjusting for the most significant covariates, age [hazard ratio (HR) 1.62, 95% confidence interval (CI) 1.02-2.57], diabetes (HR 7.51, 95% CI 1.61-35.2), summed stress score (HR 2.06, 95% CI 1.07-4), and peak end-systolic volume (HR 3.62, 95% CI 1.35-9.69) were multivariable predictors of outcome. The normal perfusion pattern was associated with a low event rate independently of peak end-systolic volume. Conversely, in the case of moderate to severe perfusion abnormalities, a peak end-systolic volume greater than 74 ml was able to identify an increased risk of adverse outcome. Moreover, peak end-systolic volume was significantly higher among patients who died of a cardiac cause compared with those with different outcomes. CONCLUSION: A combined assessment of left ventricular perfusion and function by gated SPECT significantly improves risk stratification in hypertensive patients.
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Bigi et al. (2006) conducted a cohort in Systemic hypertension with suspected or known coronary artery disease (n=415). Peak end-systolic volume vs. Lower peak end-systolic volume was evaluated on Composite of cardiac death and acute coronary syndrome (HR 3.62, 95% CI 1.35-9.69, p=<0.05). In high-risk hypertensive patients, peak end-systolic volume was a strong independent predictor of cardiac death and acute coronary syndrome (HR 3.62), significantly improving risk stratification when combined with perfusion assessment.
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