CLINICAL RESEARCH: CARDIAC IMAGING
Acute beta-blockade reduces the extent and severity of myocardial perfusion defects with dipyridamole Tc-99m sestamibi SPECT imaging
Raymond Taillefer, MD, FRCP*,*,
Alan W. Ahlberg, MA ,
Yasmin Masood, MD,
C. Michael White, PharmD ,
Isabella Lamargese, MD, FRCP*,
Jeffrey F. Mather, MS,
Carol C. McGill, LPN and
Gary V. Heller, MD, PhD, FACC
* Department of Nuclear Medicine, Centre Hospitalier de l'Université de Montréal (pavillon Hotel-Dieu), Montréal, Canada
The Henry Low Heart Center, Division of Cardiology, Hartford Hospital, Hartford, Connecticut, USA
University of Connecticut School of Medicine, Farmington, Connecticut, USA
Manuscript received December 10, 2002;
revised manuscript received May 1, 2003,
accepted May 9, 2003.
* Reprint requests and correspondence: Dr. Raymond Taillefer, Nuclear Medicine, Centre Hospitalier de l'Université de Montréal (pavillon Hotel-Dieu), Montréal, Canada.
rtaillefer{at}hotmail.com
OBJECTIVES: The goal of this study was to examine the effect of acute beta-blockade on dipyridamole Tc-99m sestamibi myocardial perfusion imaging (DMPI).
BACKGROUND: Studies suggest that antianginal drugs may reduce the presence and severity of myocardial perfusion defects with dipyridamole stress. However, there are no data regarding specific drugs.
METHODS: Patients with catheterization-proven coronary artery disease (CAD) were enrolled in this prospective, double-blind, placebo-controlled study and randomly assigned to DMPI after placebo, low-dose metoprolol (up to 10 mg), and high-dose metoprolol (up to 20 mg). Patients underwent one Tc-99m sestamibi study at rest on a separate day. The interval between DMPI studies was  14 days. Images were interpreted by three observers blinded to clinical data using a 17-segment, five-point model. For each image, a summed stress score (SSS), summed rest score (SRS), and summed difference score (SDS) were calculated (SDS = SSS – SRS). Images with an SSS <4 were considered normal.
RESULTS: Twenty-one patients completed all four Tc-99m sestamibi studies. The sensitivity of DMPI for detection of CAD was 85.7% with placebo versus 71.4% with low- and high-dose metoprolol. In comparison with placebo, the SSS was significantly lower (p < 0.05) with low- and high-dose metoprolol (12.0 ± 10.1 vs. 8.7 ± 9.0 and 9.3 ± 10.6, respectively). The SDS also was significantly lower (8.4 ± 8.8 with placebo vs. 5.0 ± 6.7 [p < 0.001] and 5.4 ± 7.9 [p < 0.01] with low- and high-dose metoprolol, respectively).
CONCLUSIONS: The presence and severity of CAD may be underestimated in patients receiving beta-blocker therapy undergoing dipyridamole stress myocardial perfusion imaging.
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Abbreviations and Acronyms
| | CAD | = coronary artery disease | | DMPI | = dipyridamole myocardial perfusion imaging | | LAD | = left anterior descending coronary artery | | MPI | = myocardial perfusion imaging | | RCA | = right coronary artery | | SDS | = summed difference score | | SPECT | = single-photon emission computed tomography | | SRS | = summed rest score | | SSS | = summed stress score |
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