How did the COVID-19 pandemic affect SPECT myocardial perfusion scans?

ABSTRACT

Objectives: The aim of this study is to evaluate the effect of the COVID-19 pandemic on myocardial perfusion scans (MPS) during the COVID-19 pandemic period. Method(s) We respectively reviewed single photon emission computed tomography myocardial perfusion scans (SPECT-MPS) performed between June and September 2020 during the COVID-19 pandemic at the Nuclear Medicine Research Center at Mashhad University of Medical Sciences. The findings of stress SPECT-MPS studies acquired in the corresponding months of 2019 were also evaluated for direct comparison. Result(s) In COVID-19 pandemic compared to period prior to the pandemic, no difference was observed in terms of age range of patients under study or their cardiovascular risk factors, except smoking which underwent a significant increase during the COVID-19 pandemic ( 19% vs. 13% , p = 0.009). While the number of patients with non-angina (19% vs. 31%, p = 0.000) or typical (11% vs. 19%, p = 0.000) chest pain significantly decreased during the COVID-19 pandemic, atypical (42% vs. 25%, p = 0.000) chest pain cases showed an increasing number. By considering pretest probability of the patients (high, intermediate and low/very low), during the COVID-19 period, cases of high pretest probability decreased (6% vs. 18%, p = 0.000) and intermediate pretest probability patients also increased (64% vs. 55%, p = 0.005) while low/very low pretest probability cases showed no changes between the two periods. All types of MPS stress tests in the COVID-19 period were pharmacological compared to exercise stress test. No statistically significant difference on the myocardial ischemia or cardiomyopathy between patients between the two periods was observed. Summed stress score (SSS) and summed rest score (SRS) was similar over the two periods,while summed difference score (SDS) significantly increased over the course of COVID-19, confirming a non- increasing pattern of myocardial ischemia. Conclusion(s) Previous research underscores the fact that the number of stress SPECT-MPS studies was significantly reduced during the COVID-19 pandemic compared to the corresponding months prior to the pandemic [1, 2]. Our study concluded that all types of MPS stress tests in the COVID-19 period were pharmacological. This is due to the fact that all related recommendations published in the literature [3] highlighted the avoidance of exercise stress tests during the COVID-19 pandemic to reduce the risk of droplet exposure. During the COVID-19 pandemic, patients in two ends of the spectrum (e.g., non-angina & typical chest pain) were referred less for MPS. However, patients in the middle of the spectrum (e.g., atypical chest pain) underwentMPS less frequently. Myocardial ischemia and cardiomyopathy were not decreased or increased in patients over the COVID-19 period.