Document Detail


Positron emission tomography-measured abnormal responses of myocardial blood flow to sympathetic stimulation are associated with the risk of developing cardiovascular events.
MedLine Citation:
PMID:  15862426     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Thomas H Schindler; Egbert U Nitzsche; Heinrich R Schelbert; Manfred Olschewski; James Sayre; Michael Mix; Ingo Brink; Xiao-Li Zhang; Michael Kreissl; Nobuhisa Magosaki; Hanjoerg Just; Ulrich Solzbach
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Publication Detail:
Type:  Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  45     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2005 May 
Date Detail:
Created Date:  2005-05-02     Completed Date:  2005-05-19     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1505-12     Citation Subset:  AIM; IM    
Affiliation:
Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California 90095-6948, USA. tschindler@mednet.ucla.edu
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MeSH Terms
Descriptor/Qualifier:
Ammonia / diagnostic use
Blood Flow Velocity
California / epidemiology
Coronary Angiography
Coronary Artery Disease / pathology,  physiopathology,  radionuclide imaging*
Coronary Circulation / physiology
Female
Germany / epidemiology
Humans
Incidence
Male
Middle Aged
Myocardial Infarction / epidemiology*,  etiology,  mortality
Nitrogen Radioisotopes / diagnostic use
Positron-Emission Tomography* / adverse effects
Prospective Studies
Radiopharmaceuticals / diagnostic use
Survival Analysis
Switzerland / epidemiology
Grant Support
ID/Acronym/Agency:
HL 331777/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Nitrogen Radioisotopes; 0/Radiopharmaceuticals; 7664-41-7/Ammonia

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