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Positron Emission Tomography-Measured Abnormal Responses of Myocardial Blood Flow to Sympathetic Stimulation Are Associated With the Risk of Developing Cardiovascular Events
Open accessAbstract
Objectives We sought to assess prospectively whether patients with normal coronary angiograms but with impaired myocardial blood flow (MBF) increases to cold pressor testing (CPT) are at increased risk for cardiovascular events.Background Invasive angiographic assessments of coronary vasomotor function have demonstrated an impairment of endothelium-related coronary flow increases to independently predict future cardiovascular events. It is unknown whether noninvasive positron emission tomography (PET)-measured MBF alterations to sympathetic stimulation with CPT are associated with the risk of developing cardiovascular events.Methods A total of 72 patients (44 men, 28 women, age 58 +/- 8 years) referred for diagnostic cardiac catheterization were studied. Myocardial blood flow was measured in absolute units with (13)N-ammonia using PET, at baseline and during CPT in each patient. Cardiovascular events (cardiovascular death, acute coronary syndrome, myocardial infarction, percutaneous transluminal coronary angioplasty, coronary artery bypass grafting, ischemic stroke, or peripheral revascularization) were assessed as clinical outcome parameters over a mean follow-up period of 66 +/- 8 months. Patients were assigned to three groups: group 1, patients with >/=40% increase in MBF (%DeltaMBF), n = 22; group 2, patients with >0 and <40% increases in MBF, n = 32; and group 3, patients with decreases in MBF (</=0%), n = 18.Results During follow-up, one of the group 1 patients developed a cerebral stroke. In group 2, 15 cardiovascular events occurred in 9 patients and in group 3, 7 patients experienced 9 cardiovascular events (p </= 0.0001, univariate by log-rank test). Impaired MBF increases in group 2 and group 3 were associated with a significantly higher incidence of cardiovascular events by Kaplan-Meier analysis (p = 0.033, log-rank test). After adjusting for known coronary risk factors, MBF responses to CPT revealed a nonsignificant trend to be independently associated with a higher incidence for cardiovascular events (p = 0.065, multivariate by Cox regression model).Conclusions Noninvasive PET-measured impaired MBF increases to sympathetic stimulation are associated with the risk of developing cardiovascular events.
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“Nevertheless, because impairment of coronary endothelial function (32) and specifically impaired MBF response as assessed by PET (33) have been shown to be independent predictors of unfavorable cardiovascular outcome, our results may at least raise questions about safety in patients with impaired MFR, such as CAD patients.”
From Caffeine decreases exercise-induced myocardial flow reserve (2006) · cites this paper as [33]
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Self-citation
Metadata
- Authors
- Schindler, T. H., Nitzsche, E. U., Schelbert, H. R., Olschewski, M., Sayre, J., Mix, M., Brink, I., Zhang, X.-L., Kreissl, M., Magosaki, N., Just, H., & Solzbach, U.
- Affiliations
- University of Freiburg (DE)
- University of Basel (CH)
- University of California, Los Angeles (US)
- Corresponding author
- Schindler, Thomas H.
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2005-05
- Volume
- 45
- Issue
- 9
- Pages
- 1505-1512
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2064009926
- Cited by
- 149
- References
- 29
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 4 · 2023: 2 · 2022: 4 · 2021: 2 · 2020: 2 · 2019: 5 · 2018: 5 · 2017: 7 · 2016: 8 · 2015: 14 · 2014: 14 · 2013: 4 · 2012: 10
- FWCI
- 6.90
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- FreiDok plus (Universitätsbibliothek Freiburg) (submittedVersion)
- Funders
- Deutsche Forschungsgemeinschaft
- National Heart, Lung, and Blood Institute (HL-331777)
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Coronary Interventions and Diagnostics
- Keywords
- myocardial blood flow, cold pressor test, sympathetic stimulation, coronary vasomotor function, endothelial dysfunction, cardiovascular events, 13N-ammonia PET, cardiovascular risk prediction, stroke, myocardial ischemia, coronary artery disease prognosis, follow-up outcomes, acute coronary syndrome, myocardial infarction
- MeSH terms
- Ammonia, Blood Flow Velocity, California, Coronary Artery Disease, Coronary Circulation, Female, Germany, Humans, Male, Middle Aged, Myocardial Infarction, Nitrogen Radioisotopes, Prospective Studies, Switzerland, Incidence, Survival Analysis, Coronary Angiography, Radiopharmaceuticals, Positron-Emission Tomography
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