title: Can the cold pressor test predict future cardiovascular events in patients without demonstrated ischemic heart disease by SPECT?
abstract: OBJECTIVE
  To assess whether a cold pressor test (CPT) could help identify patients at a high risk of cardiovascular events in a population without known coronary artery disease (CAD) with a normal myocardial perfusion scintigraphy (MPS).
  
  
  METHODS
  Our population consisted of 870 patients with a mean age of 59.3years with several CAD risk factors, having been referred for an MPS. The CPT was performed between the third day and fifth day after the MPS.
  
  
  RESULTS
  The CPT was positive in 38.2% of the patients. After a mean 40-month follow-up, the patients were contacted to check for cardiac death, non-fatal myocardial infarction, and myocardial revascularization procedures. The event-free survival rates were 98.1% and 90.4% after a negative or positive CPT, respectively (p=0.0001). The positive CPT group exhibited a fourfold increased risk of CV events. All CV events in the negative CPT group occurred after a 30-month follow-up. The risk of CV events was 4.5 times higher in diabetic patients.
  
  
  CONCLUSIONS
  A positive CPT in patients with a negative MPS could help identify a subgroup of patients at a higher risk of developing symptomatic CAD.
  
  
  CONCLUSIONS
  Our results suggest that after a normal post-exercise MPS, patients should undergo a CPT.
authors.affiliation: Centro de Cardiologia Nuclear, Buenos Aires, Argentina. Electronic address: epautasso@hotmail.com.
authors.forename: Enrique
authors.initials: E
authors.lastname: Pautasso
authors.affiliation: Centro de Cardiologia Nuclear, Buenos Aires, Argentina.
authors.forename: Martin
authors.initials: M
authors.lastname: Koretzky
authors.affiliation: Sanatorio San Lucas, CABA, Argentina; Hospital Italiano de Buenos Aires, CABA, Argentina.
authors.forename: Leopoldo
authors.initials: L
authors.lastname: Marcon
authors.affiliation: Sanatorio San Lucas, CABA, Argentina; Hospital Italiano de Buenos Aires, CABA, Argentina.
authors.forename: Carlos
authors.initials: C
authors.lastname: Borrego
authors.affiliation: Hospital de San Isidro, Buenos Aires, Argentina.
authors.forename: Julio
authors.initials: J
authors.lastname: Panini
authors.affiliation: Hospital de Clínicas José de San Martín, CABA, Argentina.
authors.forename: Jorge
authors.initials: J
authors.lastname: Lerman
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D003080:Cold Temperature; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods
keywords: Cold pressor test; Endothelial dysfunction; Ischemic heart disease