Effect of ursodeoxycholic acid in facilitating early hepatic clearance of radiotracer among patients undergoing 99mTc-sestamibi myocardial perfusion scintigraphy: A randomized double blind placebo controlled parallel trial
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Infra-cardiac tracer activity due to persistent hepatic activity interferes in inferior and infero-septal wall assessment during 99mTc-MIBI SPECT/CT myocardial perfusion scintigraphy (MPS) in evaluation of patients with coronary artery disease. It affects image interpretation with increased study duration. Ursodeoxycholic acid (UDCA) is known to enhance hepatic excretion of bilirubin and bile salts, though its role in enhancing the hepatic tracer clearance in facilitating cardiac imaging is not known.
This prospective, randomized double-blind, placebo controlled clinical trial of 120 patients, referred for adenosine stress or viability MPS studies were randomized 1:1 to receive either UDCA or placebo. Outcome was quantitative & qualitative improvement in imaging for better interpretation and to reduce the waiting time for scan.
118 participants (59 ± 11.9 years; 84 men) underwent adenosine stress MPS or viability MPS. Sixty participants had UDCA while 58 had placebo intervention. The study showed significant decrease in liver counts with improved myocardial to liver ratio at 30 and 60 minutes in adenosine stress MPS group, and marginally significant alteration in liver counts at 60 minutes in viability MPS group receiving UDCA, resulting in better images.
UDCA intervention in MPS provides early and better image due to faster hepatic tracer clearance.
Keywords99mTc-MIBI Adenosine stress Viability MPS SPECT/CT UDCA (ursodeoxycholic acid) Liver clearance
Myocardial perfusion scintigraphy
Coronary artery disease
Randomized control trial
Single photon emission computed tomography/computed tomography
American Society of Nuclear Cardiology
The authors acknowledge Prof. Suresh Kumar Sharma, Department of Statistics, Panjab University, Chandigarh for his valuable inputs.
Drs Ashwani Sood, Deepa Singh, Usha Dutta, Bhagwant Rai Mittal, Madan Parmar, Gurvinder Kaur, Komalpreet Kaur have nothing to disclose. No financial support was received for the publication of this manuscript.
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