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In this extensive review, Zoghbi et al (1) focus on the effects of medications on stress myocardial perfusion imaging. Anti-ischemia medications may decrease the size of perfusion defects, cause fals-negative results, and decrease the diagnostic accuracy of the test. On the other hand, improvement in perfusion pattern has been associated with a decrease in the risk of cardiac death or myocardial infarction, especially in patients with a severely abnormal baseline study. After discussing some technical issues, the authors summarize the available evidence based on both experimental and clinical studies for nitrates, beta-blockers, calcium channel blockers and lipid-lowering agents. Also the results of two recent trials, the INSPIRE trial and the COURAGE nuclear substudy are discussed.
This review gives an up-to-date summary of the available data regarding anti ischemic medications and may help clinicians to decide when to discontinue cardiac medications before stress patients in patients that are evaluated for diagnostic purposes.
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