title: Prognostic significance of blood pressure response during vasodilator stress Rb-82 positron emission tomography myocardial perfusion imaging.
abstract: A drop in blood pressure (BP) or blunted BP response is an established high-risk marker during exercise myocardial perfusion imaging (MPI); however, data are sparse regarding the prognostic value of BP response in patients undergoing vasodilator stress rubidium-82 (Rb-82) Positron Emission Tomography (PET) MPI.
  
  
  
  From the PET Prognosis Multicenter Registry, a cohort of 3413 patients underwent vasodilator stress Rb-82 PET MPI with dipyridamole or adenosine. We used multivariable Cox proportional hazard regression to analyze the association with mortality of four BP variables: stress minus rest systolic BP (∆SBP), stress minus rest diastolic BP (∆DBP), resting systolic BP (rSBP), and resting diastolic BP (rDBP). Covariates that had univariate P values <.10 were entered into the multivariable model. After median 1.7 years follow-up, 270 patients died. In univariate analyses, ∆SBP (P = .082), rSBP (P = .008), and rDBP (P < .001) were of potential prognostic value (P < .10), but ∆DBP was not (P = .96). After adjustment for other clinical and MPI variables, ∆SBP no longer independently predicted mortality (P = .082); only lower rSBP (P = .026) and lower rDBP (P = .045) remained independently prognostic.
  
  
  
  In patients undergoing vasodilator stress MPI, only lower resting BP is an independent predictor of mortality along with other clinical and MPI variables; BP response does not appear to add to risk stratification in these patients.
authors.affiliation: Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1462 Clifton Rd., Room 503, Atlanta, GA, 30322, USA. bwitbro@emory.edu.
authors.forename: Bradley
authors.initials: B
authors.lastname: Witbrodt
authors.affiliation: Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1462 Clifton Rd., Room 503, Atlanta, GA, 30322, USA.
authors.forename: Abhinav
authors.initials: A
authors.lastname: Goyal
authors.affiliation: Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1462 Clifton Rd., Room 503, Atlanta, GA, 30322, USA.
authors.forename: Anita A
authors.initials: AA
authors.lastname: Kelkar
authors.affiliation: Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Sharmila
authors.initials: S
authors.lastname: Dorbala
authors.affiliation: Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, USA.
authors.forename: Benjamin J W
authors.initials: BJW
authors.lastname: Chow
authors.affiliation: Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Marcelo F
authors.initials: MF
authors.lastname: Di Carli
authors.affiliation: Geisinger Medical Center, Danville, PA, USA.
authors.forename: Brent A
authors.initials: BA
authors.lastname: Williams
authors.affiliation: Niagara Falls Memorial Medical Center, Buffalo, NY, USA.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Merhige
authors.affiliation: Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Berman
authors.affiliation: Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Guido
authors.initials: G
authors.lastname: Germano
authors.affiliation: Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, USA.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Beanlands
authors.affiliation: Weill Cornell Medical College New York, New York, NY, USA.
authors.forename: James K
authors.initials: JK
authors.lastname: Min
authors.affiliation: Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, USA.
authors.forename: Punitha
authors.initials: P
authors.lastname: Arasaratnam
authors.affiliation: Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, USA.
authors.forename: Masoud
authors.initials: M
authors.lastname: Sadreddini
authors.affiliation: Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, USA.
authors.forename: Marjolein Lidwine
authors.initials: ML
authors.lastname: van Velthuijsen
authors.affiliation: Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1462 Clifton Rd., Room 503, Atlanta, GA, 30322, USA.
authors.forename: Leslee J
authors.initials: LJ
authors.lastname: Shaw
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000187:drug effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D049268:Positron-Emission Tomography / Q000379:methods*; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D012414:Rubidium Radioisotopes; D014665:Vasodilator Agents / Q000494:pharmacology*
chemical_list: D012414:Rubidium Radioisotopes; D014665:Vasodilator Agents
keywords: Blood pressure response; myocardial perfusion imaging (MPI); positron emission tomography (PET); prognosis; vasodilator stress