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

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

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