The Effects of Medications on Myocardial Perfusion

Abstract

Antianginal and lipid-lowering medications may modify the results of stress myocardial perfusion imaging. Several studies have shown the beneficial potential of these agents in suppressing myocardial ischemia in patients with known coronary artery disease. The effects of nitrates, calcium-channel blockers, beta-blockers, and statins on myocardial perfusion imaging are likely attributable to changes in myocardial blood flow and myocardial oxygen supply-demand ratio. This comprehensive review examines relevant experimental and clinical published data. Technical issues in image interpretation specific to myocardial perfusion imaging and implications of use of cardiac medications to results of myocardial perfusion imaging are discussed.

ASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers

“…(2) BP medication(s) with antianginal properties (bblocker, calcium channel blocker, and nitrates) will lower a stress test's diagnostic utility. 8 Generally, discontinuation of these medicines is left to the discretion of the referring physician. Regularly taken medication should be recorded prior to testing.…”

“…(7) Hemorrhagic and ischemic cerebrovascular accidents have occurred. (8) Due to the exceedingly short half-life of adenosine (\10 seconds), most side effects resolve in a few seconds after discontinuation of the adenosine infusion, and IV aminophylline administration is only rarely required.…”

The next generation of prognostic series: Where we can improve on risk stratification?

“…Importantly, the inclusion of unstable angina as an event may provide important clues as to the sequelae of ischemia severity; in particular as it relates to guiding anti-ischemic therapy use. 10,11 The documentation of electrocardiographic abnormalities and the exclusion of cardiac biomarker elevations remains a vital part of having a degree of consistency and rigor to the definition of unstable angina. Other endpoints such as transient ischemia attacks or stroke are largely ignored in the field of nuclear cardiology, but as we know atherosclerotic disease is systemic and the link to this common disease process remains important to define the predictive value of nuclear cardiology as a guide to advancing disease states (even non-cardiac).…”

Automated assessment of serial SPECT myocardial perfusion images

“…Could serial imaging be used to assess progression or regression of left ventricular (LV) ischemia and thereby dynamically track risk, define the impact of a novel or old anti-ischemic therapy, or meet the standards of the Food and Drug administration (FDA) for approval of a new therapy, imaging agent, or stress agent? [2][3][4][5] The basic argument is not really whether quantitative analysis is needed to assess such serial changes in perfusion, but whether an automated program or a semiquantitative visual analysis should be routinely utilized. Our field has many examples that attest to the merits of automated analysis by gated SPECT for measuring many indices of LV function such as ejection fraction (EF), volumes, wall motion and thickening, transient dilation, and the more recently described indices of dyssynchrony by phase analysis.…”

“…It is very likely that a simple definition of normal versus abnormal, or small, medium, and large will not be sufficient to answer these questions, and hence, a more ''quantitative'' method is required. 2,7 A brief summary might be helpful at this point.…”