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Nuklearmedizin 2016; 55(01): 29-33
DOI: 10.3413/Nukmed-0769-15-09
Original article
Schattauer GmbH

The effect of beta blocker withdrawal on myocardial SPECT modeled from adenosine 13N-ammonia PET

Wirkung von Betablockern auf virtuelle, aus 13N-Ammoniak-Adenosin-PETs modellierten Myokard-SPECTs
K. Hoffmeister
1   Institute of Radiology, Nuclear Medicine and Molecular Imaging Heart and Diabetes Center North Rhine-Westphalia, University Hospital of the Ruhr-University Bochum, Bad Oeynhausen, Germany
,
R. Preuss
1   Institute of Radiology, Nuclear Medicine and Molecular Imaging Heart and Diabetes Center North Rhine-Westphalia, University Hospital of the Ruhr-University Bochum, Bad Oeynhausen, Germany
,
R. Weise
1   Institute of Radiology, Nuclear Medicine and Molecular Imaging Heart and Diabetes Center North Rhine-Westphalia, University Hospital of the Ruhr-University Bochum, Bad Oeynhausen, Germany
,
W. Burchert
1   Institute of Radiology, Nuclear Medicine and Molecular Imaging Heart and Diabetes Center North Rhine-Westphalia, University Hospital of the Ruhr-University Bochum, Bad Oeynhausen, Germany
,
O. Lindner
1   Institute of Radiology, Nuclear Medicine and Molecular Imaging Heart and Diabetes Center North Rhine-Westphalia, University Hospital of the Ruhr-University Bochum, Bad Oeynhausen, Germany
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Publikationsverlauf

received: 23. September 2015

accepted in revised form: 27. November 2015

Publikationsdatum:
19. Dezember 2017 (online)

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Summary

Aim: The effect of beta blockers (BB) on myocardial imaging has been studied in several SPECT and PET studies with divergent results concerning perfusion and impact on diagnostic accuracy. The present study evaluated the effect of BB withdrawal on virtual SPECT studies modeled from quantitative PET perfusion scans. Patients, methods: Data from 20 CAD patients scheduled for adenosine 13N-ammonia imaging with and without BB were considered. Modeling the uptake characteristics of 99mTc-MIBI, all parametric stress PET polarmaps were transferred to virtual 20-segment SPECT polarmaps. The SPECT studies were categorized with a 5-point score and read to assess the effect of the BB withdrawal on scan result and interpretation. Results: The SPECT analysis revealed a mean score of 6.0 ± 4.7 with, and of 5.9 ± 4.5 without BB (p = 0.84). In 260 (74.9%) segments the scores were equal in both conditions. Without BB a downstaging was recorded in 44 segments (12.7%), an upstaging in 43 segments (12.4%). An essentially different interpretation (shift from medical therapy recommendation to angiography) was recorded in one patient. In six cases the interpretation differed mildly. Conclusion: In the majority of patients studied, scan results and interpretation remain unchanged after discontinuation of the BB. Nevertheless, the segmental scan results are not uniformly affected. The recommendation to stop BBs prior to stress testing in order to ensure the highest MBF remains advisable. If temporary BB withdrawal is unfeasible due to contraindications, a tight clinical schedule, or because a patient forgot to withhold the BB, it is appropriate to perform adenosine stress testing according to the results of this study.

Zusammenfassung

Ziel: Der Einfluss einer Betablocker-Medikation auf die kardiale PET- und SPECT-Perfusionsdiagnostik hat in Studien divergierende Ergebnisse in Bezug auf die Perfusion und die diagnostische Genauigkeit erbracht. In dieser Studie wurde der Einfluss einer Betablocker (BB) Pausierung auf virtuelle SPECT-Studien, die aus quantitativen PET-Messungen, abgeleitet wurden, untersucht. Patienten, Methodik: Quantitative Adenosin-13N- Ammoniak-PET-Daten wurden von 20 KHK-Patienten mit und ohne BB ausgewertet. Unter Berücksichtigung der Perfusions-Uptake-Charakteristik von 99mTc-MIBI wurden aus parametrischen PET-Polartomogrammen 20-Segment virtuelle SPECT-Polartomogramme errechnet. Die SPECT-Studien wurden mit einem 5-Punkte-Score bewertet und beurteilt. Ergebnisse: Der mittlere SPECT-Score betrug 6,0 ± 4,7 mit BB, und 5,9 ± 4,5 ohne (p = 0.84). Bei 260 Segmenten (74,9%) zeigten sich keine Unterschiede im Score. Ohne BB ergab sich ein Downstaging in 44 Segmenten (12,7%) und ein Upstaging bei 43 (12,4%). Eine signifikante Änderung bei der Beurteilung (Änderung von konservativem Vorgehen zu Angiographieempfehlung) zeigte sich bei einem Patienten. In sechs Fällen ergaben sich geringe Änderungen in der Beurteilung. Schlussfolgerung: Bei den meisten Patienten änderten sich Ergebnis und Beurteilung nach Pausierung des Betablockers nicht. Allerdings zeigten die Scores einzelner Segmente unterschiedliche Tendenzen. Die Empfehlung, einen BB vor der Myokard-SPECT abzusetzen, um einen hohen Blutfluss zu gewährleisten, besteht weiterhin. Wenn das Absetzen des BB aufgrund von Kontraindikationen, zeitlichen Gründen oder weil es vergessen wurde, nicht möglich ist, ist eine Adenosin-Belastung gut zu vertreten.

Keywords

Myocardial perfusion imaging - beta blocker - adenosine - SPECT - PET

Schlüsselwörter

Myokardiale Perfusionsbildgebung - Beta-blocker - Adenosin - SPECT - PET
 

  • References

  • 1 Bottcher M, Refsgaard J, Madsen MM. et al. Effect of antianginal medication on resting myocardial perfusion and pharmacologically induced hyperemia. J Nucl Cardiol 2003; 10: 345-352.
    CrossrefPubMedSuche in Google Scholar
  • 2 Bridges AB, Kennedy N, McNeill GP. et al. The effect of atenolol on dipyridamole 201Tl myocardial perfusion tomography in patients with coronary artery disease. Nucl Med Commun 1992; 13: 41-46.
    CrossrefPubMedSuche in Google Scholar
  • 3 Dorbala S, Di Carli MF, Delbeke D. et al. SNMMI/ASNC/SCCT guideline for cardiac SPECT/CT and PET/CT 1.0. J Nucl Med 2013; 54: 1485-1507.
    CrossrefPubMedSuche in Google Scholar
  • 4 Glover DK, Ruiz M, Edwards NC. et al. Comparison between 201Tl and 99mTc sestamibi uptake during adenosine-induced vasodilation as a function of coronary stenosis severity. Circulation 1995; 91: 813-820.
    CrossrefPubMedSuche in Google Scholar
  • 5 Gould KL, Lipscomb K. Effects of coronary stenoses on coronary flow reserve and resistance. Am J Cardiol 1974; 34: 48-55.
    CrossrefPubMedSuche in Google Scholar
  • 6 Hachamovitch R, Berman DS. The use of nuclear cardiology in clinical decision making. Semin Nucl Med 2005; 35: 62-72.
    CrossrefPubMedSuche in Google Scholar
  • 7 Hachamovitch R, Berman DS, Shaw LJ. et al. Incremental prognostic value of myocardial perfusion SPECT for the prediction of cardiac death. Circulation 1998; 97: 535-543.
    CrossrefPubMedSuche in Google Scholar
  • 8 Hachamovitch R, Hayes SW, Friedman JD. et al. Comparison of the short-term survival benefit associated with revascularization compared with medical therapy in patients with no prior coronary artery disease undergoing stress myocardial perfusion SPECT. Circulation 2003; 107: 2900-2907.
    CrossrefPubMedSuche in Google Scholar
  • 9 Hoffman JI. Maximal coronary flow and the concept of coronary vascular reserve. Circulation 1984; 70: 153-159.
    CrossrefPubMedSuche in Google Scholar
  • 10 Hoffmeister C, Preuss R, Weise R. et al. The effect of beta blocker withdrawal on adenosine myocardial perfusion imaging. J Nucl Cardiol 2014; 21: 1223-1229.
    CrossrefPubMedSuche in Google Scholar
  • 11 Jaarsma C, Leiner T, Bekkers SC. et al. Diagnostic performance of noninvasive myocardial perfusion imaging using SPECT, cardiac MR, and PET imaging for the detection of obstructive coronary artery disease. J Am Coll Cardiol 2012; 59: 1719-1728.
    CrossrefPubMedSuche in Google Scholar
  • 12 Lakkireddy D, Aronow WS, Bateman T. et al. Does beta blocker therapy affect the diagnostic accuracy of adenosine SPECT myocardial perfusion imaging?. Am J Ther 2008; 15: 19-23.
    CrossrefPubMedSuche in Google Scholar
  • 13 Lindner O, Bengel FM, Hacker M. et al. Use of myocardial perfusion imaging and estimation of associated radiation doses in Germany from 2005 to 2012. Eur J Nucl Med Mol Imaging 2014; 41: 963-971.
    CrossrefPubMedSuche in Google Scholar
  • 14 Lindner O, Burchert W, Hacker M. et al. Myocardial perfusion scintigraphy. Nuklearmedizin 2013; 52: 51-63.
    Thieme ConnectPubMedSuche in Google Scholar
  • 15 Muller-Suur R, Eriksson SV, Strandberg LE, Mesko L. Comparison of adenosine and exercise stress test for quantitative perfusion imaging in patients on beta-blocker therapy. Cardiology 2001; 95: 112-118.
    CrossrefPubMedSuche in Google Scholar
  • 16 Nandalur KR, Dwamena BA, Choudhri AF. et al. Diagnostic performance of PET in the detection of coronary artery disease. Acad Radiol 2008; 15: 444-451.
    CrossrefPubMedSuche in Google Scholar
  • 17 Parker MW, Iskandar A, Limone B. et al. Diagnostic accuracy of cardiac PET versus SPECT for coronary artery disease. Circ Cardiovasc Imaging 2012; 5: 700-707.
    CrossrefPubMedSuche in Google Scholar
  • 18 Reyes E, Stirrup J, Roughton M. et al. Attenuation of adenosine-induced myocardial perfusion heterogeneity by atenolol and other cardioselective beta-adrenoceptor blockers. J Nucl Med 2010; 51: 1036-1043.
    CrossrefPubMedSuche in Google Scholar
  • 19 Sharir T, Rabinowitz B, Livschitz S. et al. Underestimation of extent and severity of coronary artery disease by dipyridamole stress thallium-201 SPECT myocardial perfusion imaging in patients taking antianginal drugs. J Am Coll Cardiol 1998; 31: 1540-1546.
    CrossrefPubMedSuche in Google Scholar
  • 20 Taillefer R, Ahlberg AW, Masood Y. et al. Acute beta-blockade reduces the extent and severity of myocardial perfusion defects with dipyridamole Tc-99m sestamibi SPECT imaging. J Am Coll Cardiol 2003; 42: 1475-1483.
    CrossrefPubMedSuche in Google Scholar
  • 21 Verberne HJ, Acampa W, Anagnostopoulos C. et al. EANM procedural guidelines for radionuclide myocardial perfusion imaging with SPECT and SPECT/CT. Eur J Nucl Med Mol Imaging 2015; 42: 1929-1940.
    CrossrefPubMedSuche in Google Scholar
  • 22 Wijns W, Kolh P, Danchin N. et al. Guidelines on myocardial revascularization. Eur Heart J 2010; 31: 2501-2555.
    CrossrefPubMedSuche in Google Scholar
  • 23 Yoon AJ, Melduni RM, Duncan SA. et al. The effect of beta-blockers on the diagnostic accuracy of vasodilator pharmacologic SPECT myocardial perfusion imaging. J Nucl Cardiol 2009; 16: 358-367.
    CrossrefPubMedSuche in Google Scholar
  • 24 Zoghbi GJ, Dorfman TA, Iskandrian AE. The effects of medications on myocardial perfusion. J Am Coll Cardiol 2008; 52: 401-416.
    CrossrefPubMedSuche in Google Scholar
  • 25 Zoghbi GJ, Iskandrian AE. Selective adenosine agonists and myocardial perfusion imaging. J Nucl Cardiol 2012; 19: 126-141.
    CrossrefPubMedSuche in Google Scholar