Underestimation of Extent and Severity of Coronary Artery Disease by Dipyridamole Stress Thallium-201 Single-Photon Emission Computed Tomographic Myocardial Perfusion Imaging in Patients Taking Antianginal Drugs

Sharir, Tali; Rabinowitz, Babeth; Livschitz, Shy; Moalem, I; Baron, Jack; Kaplinsky, Elieser; Chouraqui, Pierre

doi:10.1016/s0735-1097(98)00142-9

Cited by 81 publications

(36 citation statements)

References 37 publications

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“…This observation is in agreement with a previous report demonstrating that b-blockade with metoprolol decreases the sensitivity of dipyridamole MPI for the detection of individual stenosis by 24% (4). Altogether, these results confirm earlier observations suggesting that antianginal drugs might adversely affect the diagnostic accuracy of vasodilator imaging (5,6,12). …”

Section: Discussionsupporting

confidence: 90%

“…Until recently, it was thought that b-blockers had no effect on the action of primary coronary vasodilators (1). However, studies with dipyridamole have challenged this view (4,5). Treatment with a b 1 -adrenoceptor blocker attenuated the coronary hyperemic response to dipyridamole as measured by 13 N-ammonia PET (6) and reduced the magnitude of inducible perfusion abnormalities on dipyridamole MPI (4).…”

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confidence: 99%

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

Reyes

Stirrup²,

Roughton³

et al. 2010

J Nucl Med

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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.

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Section: Discussionsupporting

confidence: 90%

mentioning

confidence: 99%

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

Reyes

Stirrup²,

Roughton³

et al. 2010

J Nucl Med

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“…In addition, adenosine increased the median heart rate to 69 beats per minute (interquartile range, 60-78 beats per minute), potentially increasing motion artifacts that may be mistaken for perfusion abnormalities. Recognizing these issues, we prespecified a SSS threshold of at in general, antianginal drugs reduce ischemic burden at SPECT (25). Sharir et al (25) previously demonstrated that antianginal drugs reduce myocardial ischemia most effectively in the territory of the left anterior descending and left circumflex arteries, with no significant reduction in the territory of the right coronary artery.…”

Section: Disclosures Of Conflicts Of Interest: Rtgmentioning

confidence: 99%

Myocardial CT Perfusion Imaging and SPECT for the Diagnosis of Coronary Artery Disease: A Head-to-Head Comparison from the CORE320 Multicenter Diagnostic Performance Study

George¹,

Mehra²,

Chen³

et al. 2014

Radiology

105

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Purpose:To compare the diagnostic performance of myocardial computed tomographic (CT) perfusion imaging and single photon emission computed tomography (SPECT) perfusion imaging in the diagnosis of anatomically significant coronary artery disease (CAD) as depicted at invasive coronary angiography. Materials and Methods:This study was approved by the institutional review board. Written informed consent was obtained from all patients. Sixteen centers enrolled 381 patients from November 2009 to July 2011. Patients underwent rest and adenosine stress CT perfusion imaging and rest and either exercise or pharmacologic stress SPECT before and within 60 days of coronary angiography. Images from CT perfusion imaging, SPECT, and coronary angiography were interpreted at blinded, independent core laboratories. The primary diagnostic parameter was the area under the receiver operating characteristic curve (A z ). Sensitivity and specificity were calculated with use of prespecified cutoffs.The reference standard was a stenosis of at least 50% at coronary angiography as determined with quantitative methods. Results:CAD was diagnosed in 229 of the 381 patients (60%). The per-patient sensitivity and specificity for the diagnosis of CAD (stenosis 50%) were 88% (202 of 229 patients) and 55% (83 of 152 patients), respectively, for CT perfusion imaging and 62% (143 of 229 patients) and 67% (102 of 152 patients) for SPECT, with A z values of 0.78 (95% confidence interval: 0.74, 0.82) and 0.69 (95% confidence interval: 0.64, 0.74) (P = .001). The sensitivity of CT perfusion imaging for single-and multivessel CAD was higher than that of SPECT, with sensitivities for left main, threevessel, two-vessel, and one-vessel disease of 92%, 92%, 89%, and 83%, respectively, for CT perfusion imaging and 75%, 79%, 68%, and 41%, respectively, for SPECT. Conclusion:The overall performance of myocardial CT perfusion imaging in the diagnosis of anatomic CAD (stenosis 50%), as demonstrated with the A z , was higher than that of SPECT and was driven in part by the higher sensitivity for left main and multivessel disease.q RSNA, 2014

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“…Indirect evidence indicating the potential use of stress myocardial perfusion scintigraphy in evaluating the efficacy of anti-ischemic drugs originated from studies reporting underestimation of the extent and severity of myocardial ischemia in patients submitted to pharmacological stress myocardial perfusion imaging under the effect of previous intravenous propranolol injection [34] or nondiscontinuation of routine anti-ischemic drugs [35].…”

Section: Serial Assessment Of Extent and Severity Of Myocardial Ischemiamentioning

confidence: 99%

Nuclear Cardiology Core Laboratory: State of the Art

Simões¹,

Neverve²,

Schwaiger³

et al. 2003

Heart Drug

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Considering the low mortality rate related to cardiovascular diseases achieved by the currently available therapeutic options, proving the superiority of a new drug/intervention over standard treatment using mortality as the end point requires the inclusion of several thousands of patients in a prospective randomized clinical trial. The high costs involved in such trials represent a severe limitation for the development of new therapeutic strategies. At the same time, however, there is increasing acceptance that cardiac functional parameters, changes in which are directly related to the beneficial effect of an intervention, can be used as surrogate end points in small-sample size pilot-phase studies. This study design has been shown to be advantageous not only regarding cost-saving aspects but also for providing objective evaluation of the beneficial effect of a new treatment. In addition, the design helps in establishing the number of patients to be included in the definitive trial as well as determining the best dosage to be used. This review describes the available information supporting the use of nuclear cardiology imaging to reliably assess multiple cardiac function parameters constituting adequate surrogate end points for the assessment of therapeutic effects in several cardiovascular diseases. In addition, the technical aspects, feasibility and clear advantages of the use of nuclear cardiology core laboratories for centralized imaging processing/analysis in the context of multicenter clinical trials are also presented.

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Underestimation of Extent and Severity of Coronary Artery Disease by Dipyridamole Stress Thallium-201 Single-Photon Emission Computed Tomographic Myocardial Perfusion Imaging in Patients Taking Antianginal Drugs

Abstract: Continued use of antianginal drugs before dipyridamole plus low level treadmill exercise thallium-201 SPECT may reduce the extent and severity of myocardial perfusion defects, resulting in underestimation of coronary artery disease.

Cited by 81 publications

References 37 publications

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

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

Myocardial CT Perfusion Imaging and SPECT for the Diagnosis of Coronary Artery Disease: A Head-to-Head Comparison from the CORE320 Multicenter Diagnostic Performance Study

Nuclear Cardiology Core Laboratory: State of the Art

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