Key result
Concomitant ECG abnormalities and anti-ischemic medications alter SPECT myocardial perfusion patterns, requiring tailored stress protocols.
Why the study?
Myocardial perfusion imaging plays a central role in CAD risk stratification and prognosis, but clinicians must be aware of limitations that may hinder or impact scan interpretation.
How do ECG alterations and anti-ischemic medications affect the interpretation and utility of SPECT myocardial perfusion scans?
How do ECG alterations and anti-ischemic medications affect the interpretation and utility of SPECT myocardial perfusion scans?
Clinicians must account for baseline ECG abnormalities and anti-ischemic medications when selecting the appropriate stress modality and interpreting SPECT myocardial perfusion scans to avoid misdiagnosis.
May require tailored SPECT protocols with LBBB or beta-blockers; leaves open need for prospective validation before practice change.
Coronary artery disease (CAD) is the leading cause of death followed by cancer, in men and women. With risk factors being endemic and the increasing costs of healthcare for management and treatment, myocardial perfusion imaging (MPI) finds a central role in risk stratification and prognosis for CAD patients, but it comes with its limitations in that the referring clinician and managing team must be aware of and use at their advantage. This narrative review examines the utility of myocardial perfusion scans in the diagnosis and management of patients with ECG alterations such as atrioventricular block (AVB), and medications including calcium channel blockers (CCB), beta blockers (BB), and nitroglycerin which may impact the interpretation of the exam. The review analyzes the current evidence and provides insights into the limitations, delving into the reasons behind some of the contraindications to MPI.
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Sidrak et al. (2023) conducted a review in Coronary artery disease. Medications (beta-blockers, calcium channel blockers, nitroglycerin) and ECG alterations (LBBB, AV block) was evaluated. ECG alterations like LBBB and medications such as beta-blockers and calcium channel blockers can alter myocardial perfusion patterns on SPECT imaging, necessitating tailored stress protocols and careful interpretation.
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