Anti-ischemic medication during myocardial perfusion: with or without?

摘要

Stress and rest myocardial perfusion imaging (MPI) single photon emission computed tomography are widely used for the diagnosis and risk assessment of patients with known or suspected coronary artery disease (CAD) [1]. The results of MPI for the detection of CAD can be variably affected by anti-ischemic medications. The size and severity of the perfusion defects may decrease after the use of these anti-ischemic medications, causing false-negative results, and decreasing the diagnostic accuracy of the test [2,3]. However, continuation of anti-ischemic medication during stress MPI can be done when patients are tested for prognosis (e.g. after myocardial infarction, success of revascularization, and heart failure). Some additional anti-ischemic medication, such as nitrates during rest MPI, may also improve the detection of viable myocardium. Depending on the clinical question the continuation of anti-ischemic medication should be reconsidered and there may be a need to be withdrawn to increase the accuracy of MPI for the detection of ischemia. In the case of patients with known CAD, discontinuation may not be desired because the reason for MPI is not diagnosis but cardiac event risk stratification or monitoring of anti-ischemic medication treatment. This editorial evaluates the effect of anti-ischemic medication on MPI; should we perform it with or without?