| Sumario: | Purpose: Our study aims to investigate the associations between stress-related neural activity (SNA), a quantified imaging biomarker in processing stress responses assessed by 18F-FDG-PET/CT, and cardiovascular (CV) outcomes based on available evidence. Methods: We searched databases from inception to December 1, 2024. Studies assessing the associations between SNA, as quantified by measuring FDG uptake values in the amygdala using 18F-FDG-PET/CT, and CV outcomes were included. Risk of bias was evaluated using the Newcastle–Ottawa Scale. Random-effects model was implemented for pooled effect sizes (ESs) and heterogeneity evaluation. Results: Ten studies with 3523 patients with 18F-FDG-PET/CT were included in our analysis (mean age: 58.5 years; 48.9% female). The ESs included in the analysis comprised hazard ratios (HR) and standardized mean differences (SMD). Among the studies reporting HR, 192 (11.5%) patients experienced composite adverse CV events during a mean follow-up period of 3.8 years. SNA significantly correlated with an increased risk of composite adverse CV events (pooled adjusted HR: 1.61, 95% confidence interval [CI]: 1.12, 2.32). Among the studies reported SMD, individuals experienced composite adverse CV events had significantly higher SNA values than those who did not (Hedges's g = 0.55, 95% CI: 0.14, 0.96). Conclusions: SNA, as a noninvasive quantified indicator of processing stress responses assessed by brain 18F-FDG-PET/CT, is associated with an increased risk of CV outcomes. Further research is warranted to validate these findings and to investigate the clinical utility of SNA across various demographic groups.
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