Is Cold Pressor Test Useful to Predict Cardiovascular Events in Patients with Not Documented Coronary Artery Disease?

Enrique Pautasso, Martin Koretzky, Jorge Aiub, Ricardo Foye, Carlos Borrego, Fabian De Cecco, Leopoldo Marcon, Marcelo Boscaro, Julio Panini, Jorge Lerman



To determine the prevalence of the cold pressor test in 511 patients with no proved ischemic heart disease, as well as, the associated coronary risk factors in those patients with a positive result and to analyze the incidence of cardiovascular events in a 50-month monitoring.

Material and Methods

A tomographic study of myocardial perfusion SPECT imaging was performed in 511 patients in a department of nuclear medicine, whose result versus the exercise showed uniform radiotracer uptake. No patient had history of myocardial revascularization or previous myocardial infarction. The cold pressor test was performed within 5 days after the admission protocol. The test is positive when radioisotope hypo-uptake is observed at any segment that was not present in the cardiac stress test and it is negative when there are no changes in the uptake between both studies.

The average monitoring was 24±13 months, which could be completed in 95% of the patients. Cardiac mortality, myocardial infarction, cerebrovascular accident and revascularization procedures were analyzed.


The mean age was 58.7 years with a prevalence of 52.6% in men. Prevalence of risk factors: diabetes 10.3%, dyslipidemia 69.3%, hypertension 63.4%, obesity 25.2%, and tobacco smoking 22.3%.

The test was positive in 32.4% of the patients. 3.9% of the patients did not tolerate a cold stimulus and 5.3% had vasovagal response.

During 50 months, the event-free survival was 95.6% and 86.6% in patients with negative and positive test, respectively (p < 0.01).


The prevalence of the positive cold pressor test in patients with no proved ischemic heart disease was 32.4%. Men and high body mass index were associated with a positive test. The positive cold pressor test would identify patients who could suffer from cardiovascular events.









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Revista argentina de cardiología. ISSN en línea 1850-3748. Argentine journal of cardiology (English ed. Online ISSN 2314-2286) Sociedad Argentina de Cardiología. Azcuénaga 980 (C1115AAD),Ciudad Autónoma de Buenos Aires, República Argentina. Tel. (54 11) 4961-6027/8/9 Fax: 4961-6020