Attenuation of Adenosine-Induced Myocardial Perfusion Heterogeneity by Atenolol and Other Cardioselective β-Adrenoceptor Blockers: A Crossover Myocardial Perfusion Imaging Study

Abstract

Little is known about the effect of chronic b-blockade on adenosine actions. We sought to investigate the effect of oral b-blockers on the presence, extent, and severity of myocardial perfusion abnormality induced by adenosine in patients with coronary artery disease. Methods: In this crossover study, 45 male patients with coronary artery disease on b-blocker therapy with atenolol, bisoprolol, or metoprolol underwent adenosine myocardial perfusion imaging both on and off b-blockade in a random order on separate days. Myocardial perfusion was assessed both qualitatively and quantitatively. Hemodynamic response, image analysis, and sensitivity for the detection of coronary stenosis ($50% luminal diameter reduction on x-ray coronary angiography) were compared between the on and off b-blocker studies. Results: Rate pressure product both at baseline and at peak adenosine infusion decreased by 23% 6 15% and 21% 6 18%, respectively, after b-blockade (P , 0.001 for all). The median (interquartile range) summed difference score, a measure of defect reversibility, and quantitative defect size were both significantly lower after b-blockade (median, 7.0 [interquartile range, 2.0-9.5] vs. median, 5.0 [interquartile range, 0-8.0], P 5 0.002; and quantitative defect size, 18% [interquartile range, 9%234%] vs. quantitative defect size, 6% [interquartile range, 0%219%], P , 0.001, respectively). The overall sensitivity for the detection of coronary stenosis decreased from 0.76 (95% confidence interval, 0.65-0.88) to 0.58 (95% confidence interval, 0.45-0.71) after b-blockade (P 5 0.03). Conclusion: b-blockade causes a small but significant reduction in the extent and severity of perfusion abnormality by adenosine. This may reduce the diagnostic sensitivity of adenosine myocardial perfusion imaging for the detection of flow-limiting coronary stenosis.

SNMMI/ASNC/SCCT Guideline for Cardiac SPECT/CT and PET/CT 1.0

“…However, b-blockers are generally not used with coronary artery calcium scoring. Additionally, it has been shown that the extent and severity of MPI abnormalities are reduced in patients under the effects of b-blockers (31,32). Stair-step artifacts are eliminated on 320-slice scanners wherein the entire heart volume is covered in 1-2 heartbeats (13,28), as well as with the prospectively triggered high-pitch acquisition (FLASH mode [fast-pitch spiral CT]), which requires a fraction of 1 heart beat (approximately 250 ms) for the CTA acquisition (135).…”

The effect of beta blocker withdrawal on adenosine myocardial perfusion imaging

“…On the other hand, a significant impact of beta blockers on adenosine MPI has been demonstrated in a prospective study 12. All the cited studies related to MPI in SPECT technique.…”

“…Despite maximal vasodilation by pharmacologic vasodilators, an interaction of cardiac medications such as beta blockers, calcium blockers, and nitrates has been suggested in several studies 8-12. Current guidelines recommend temporarily discontinuing beta blockers before stress testing 13,14…”

Semiconductor Detectors Allow Low-Dose–Low-Dose 1-Day SPECT Myocardial Perfusion Imaging

“…to obtain summed difference scores (SDSs). An SSS of 4 or more was considered abnormal, and an SDS of 2 or more was considered to represent clinically relevant ischemia (21)(22)(23). In addition, segments 1, 2, 7, 8, 13, 14, and 17 were assigned to the left anterior descending territory; segments 3, 4, 9, 10, and 15 to the right coronary artery territory; and segments 5, 6, 11, 12, and 16 to the left circumflex territory to allow vessel-based comparison.…”