Prognostic significance of blood pressure response during vasodilator stress Rb-82 positron emission tomography myocardial perfusion imaging

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.