Compared to 2019, the number of SPECT-MPI fell more than 80% at the height of the pandemic in March and April 2020 at the University of Alabama at Birmingham, researchers report in the retrospective study last published on January 8 in the European Journal of Nuclear Medicine and Molecular Imaging.
While the drop in studies was staggering, the researchers did not find a shift in the abnormal SPECT-MPI test rate – a trend they had expected to see, according to a team led by Dr. Fadi Hage, a cardiologist at the university.
“We were of the view that, given the limited number of tests available, only patients with a high SPECT-MPI result, while those who were expecting normal would be delayed,” the report wrote. authors. “However, we did not find a statistically or clinically significant increase in abnormal SPECT-MPI or myocardial ischemia in this period.”
The study was conducted to evaluate the impact of coronavirus pandemic on SPECT-MPI use. Along with a decline in other health care sectors, the level of medical imaging studies performed has progressed during lockouts designed to prevent the spread of the SARS-CoV-2 virus. One study found that CT lung cancer screening volume was down nearly 75% during the pandemic, while the rate of malignancies / positives rose more than 250%.
In the new study, Hage et al stated that patients receiving SPECT-MPI during the pandemic would be at a higher risk of poor prognosis, which would translate into a higher percentage of abnormal results for 2020 compared to 2019. This would be contrasted with a decline in the percentage of abnormal results that have occurred in recent years, a trend attributed to images of patients with lower risk.
Hage et al indicated that restrictions on the use of SPECT-MPI during the pandemic followed follow guidance from the American Society of Nuclear Cardiology and the Society of Nuclear Medicine and Molecular Imaging. The guidelines advised that all nonurgent SPECT-MPI studies be discontinued, which noted “significant limitations,” nationally, the authors noted.
For the study, researchers compared results for 210 patients who underwent SPECT-MPI in March and April 2020 with results drawn from 1,106 who had SPECT-MPI in a similar period to the previous year. Their analysis included a study of transmission patterns and the use of telemedicine instead of personal assessments that led to imaging studies.
“During the pandemic, there has been a national and international increase in the use of telemedicine to assess patients at a distance without face-to-face contact using technologies (audio and / or video conferencing) that have not been used on such a wide scale before, “the authors wrote.
For the pre- and maximum-monitored times, the SPECT-MPI size at the hospital fell from 553 per month to 105 per month – that is, an 81% drop from baseline. And the proportion of abnormal results for the baseline period was 31% at baseline, compared with 27% at the height of the pandemic, not a statistically significant difference. , Hage and his colleagues reported.
The following levels of abnormal results were broadly similar for the two groups studied, the authors explained, for conditions involving abnormal myocardial perfusion, perfusion deficiencies moderate, severe myocardial ischemia, myocardial scar, and abnormal left ventricular ejection fraction.
In terms of transmission patterns, they found that the appearance of an abnormal outcome was not affected whether it was assessed via telemedicine or a face-to-face visit.
“We also noted a significant shift in the signal for SPECT-MPI during the baseline pandemic,” wrote Hage et al. “There have been many more studies to assess symptom, and [fewer] studies were performed for preoperative assessment that responded to a change in referral pattern in favor of studies that provided cardiology and primary care or inpatient treatment vs. referral services . “
Patients who were excluded by cardiologists were twice as likely (40% vs. 20%) to have an abnormal result, a statistically significant result, the authors noted.
Hage et al concluded that it is “still difficult to predict which patients will have abnormal SPECT-MPI even when providers and laboratories are forced to prioritize the performance of patient studies. with a high yield. “
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