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Association between blood pressure response and myocardial perfusion outcomes in CT-MPI: a retrospective analysis

cardiology
emergency-and-critical-care
evidence-based-medicine
pathology
radiology-and-medical-imaging

Abstract

Background Stress computed tomography myocardial perfusion imaging (CT-MPI) is an effective and noninvasive technique for detecting myocardial ischemia, during which blood pressure (BP) fluctuations commonly occur. This study aimed to investigate the association between BP response to adenosine triphosphate (ATP) and myocardial ischemia during CT-MPI.

Methods: We retrospectively analyzed 118 patients who underwent stress CT-MPI. Myocardial segments with myocardial blood flow (MBF) <120 ml/min/100 ml were defined as ischemic. Patients with ten or more ischemic segments were considered to have a severe ischemic burden. The BP measurements included stress-minus-rest systolic BP (∆SBP), stress-minus-rest diastolic BP (∆DBP), rest systolic BP (rSBP), rest diastolic BP (rDBP), peak stress systolic BP (sSBP), and peak stress diastolic BP (sDBP).

Results: Forty-one patients had a severe ischemic burden. The sSBP in the severe ischemic burden group was significantly higher than that in the no severe ischemic burden group (132.97 ± 26.69 mmHg vs. 120.27 ± 13.98 mmHg, P = 0.010). The severe ischemic burden group presented a smaller decrease in SBP and DBP (∆SBP and ∆DBP) than those without severe ischemic burden did (- 6.17 ± 1 6.74 mmHg vs. - 23.05 ± 12.89 mmHg, P < 0.001; -7.69 ± 9.09 vs. -16.18 ± 10.53, P < 0.001). In multivariate logistic regression, ∆SBP was independently associated with severe ischemic burden (OR, 1.075; 95% CI: 1.029,1.1, 24 ; P = 0.001). The area under the curve (AUC) for ∆SBP in detecting severe ischemic burden was 0.7 80 (P < 0.0 01).

Conclusions During stress, CT-MPI, sSBP, ∆SBP, and ∆DBP are associated with severe ischemic burden. A blunted BP response, especially a lower ∆SBP, may serve as a useful marker for identifying patients at higher risk.

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