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Warranty period of normal stress myocardial perfusion imaging in hypertensive patients: A parametric survival analysis

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

We evaluated the warranty period of a normal stress myocardial perfusion single-photon emission computed tomography (MPS) in hypertensive patients.

Methods and Results

A total of 471 consecutive hypertensive patients with suspected coronary artery disease and normal perfusion at stress MPS were followed for a mean of 76 ± 21 months. Endpoint events were cardiac death or nonfatal myocardial infarction. With Cox analysis, age (hazard ratio 1.1, P < .005) and stress test type (hazard ratio 2.7, P < .005) were independent predictors of events. With parametric Weibull analysis, patients ≤60 years old undergoing exercise stress test remained at low risk for the entire length of follow-up, while the highest probability of events and the major risk acceleration were observed in those > 60 years old who underwent pharmacologic stress test. In patients undergoing exercise test, peak systolic blood pressure (BP; hazard ratio 1.1, P < .005) emerged as predictor of events, and only subjects with peak systolic BP < 160 mmHg remained at low risk for the entire length of follow-up. In contrast, for patients with peak systolic BP ≥180 mmHg, the time to achieve a cumulative cardiac risk level of 3% was 18 months.

Conclusions

In hypertensive patients, the warranty period of a normal stress MPS varies according to stress type and peak systolic BP. A normal stress MPS can be considered reassuring in subjects ≤60 years old who performed exercise stress test and a peak systolic BP < 160 mmHg.

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Abbreviations

CAD:

Coronary artery disease

MPS:

Myocardial perfusion single-photon emission computed tomography

ECG:

Electrocardiography

LV:

Left ventricular

EF:

Ejection fraction

AER:

Annualized event rate

BP:

Blood pressure

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Correspondence to Alberto Cuocolo MD.

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Disclosure

W. Acampa, E. Zampella, R. Assante, T. Mannarino, C. Nappi, Francesco Rozza, C.G. Mainolfi, M. Petretta, B. Trimarco, A. Cuocolo declare that they have no conflict of interest.

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Acampa, W., Rozza, F., Zampella, E. et al. Warranty period of normal stress myocardial perfusion imaging in hypertensive patients: A parametric survival analysis. J. Nucl. Cardiol. 27, 534–541 (2020). https://doi.org/10.1007/s12350-018-1285-9

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