Pautasso Enrique José
Hospital Institute of Cardiology National Medicine Academy, Argentina
Title: Is it possible to predict future cardiovascular events in patients without coronary artery disease demonstrated?
Biography
Biography: Pautasso Enrique José
Abstract
A lot of studies have been published that have demonstrated that the patients with a normal myocardial perfusion test with single positron emission tomography (SPECT) belong to the group of low coronary risk , since the incidence of cardiovascular events is less than 10 % at ten years.Endothelial dysfunction is the first alteration known that intervenes in the development of coronary artery disease and it can be evaluated by a perfusion test with SPECT and the cold pressor test (CPT). In a population of low coronary risk we could identify those patients most likely to suffer from cardiovascular events with the cold presser test. For this reason more than 1000 consecutive patients that had a normal exercise perfusion test with SPECT were admitted in a nuclear medicine center. The cold pressor test was performed between the third and fifth day after the study SPECT. The cold pressor test was considered positive if a decreased uptake of the radionuclide was observed in the perfusion images obtained during the CPT, which were normal in the respective post-exercise images and negative if no changes were observed in the radiotracer uptake in any of the myocardial perfusion images obtained after the exercise test and the CPT .The average follow-up was 51 ±16 months having located 85.4% of the population. The events analyzed were: cardiac mortality, non-fatal myocardial infarction and coronary revascularization. In this population of patients without demonstrated ischemic heart disease, the prevalence of a positive cold pressor test was 37,5%.Trough out 119 month follow up we have observed event free survival of 95% and 83% in the group of a negative and positive cold presser test respectively. In our 10 years of experience we have observed the great utility of the cold pressor test, in a low coronary risk population because with this test we could identify a subgroup of patients with a higher likelihood of suffering from cardiovascular events. On the other hand for patients with a normal SPECT but inadequate excercise test, we suggest to complete the study with the cold pressor test in order to identify patients with intermediate coronary risk. Trough the cold pressor test we have also detected the probability of future cardiovascular even in diabetes patients.
