The International Journal of Cardiovascular Imaging

, Volume 23, Issue 4, pp 511–518

Safety and feasibility of atropine added in patients with sub-maximal heart rate during exercise myocardial perfusion SPECT


    • Division of CardiologyBuccheri La Ferla Fatebenefratelli Hospital
  • Corrado Ventimiglia
    • Division of CardiologyCivico e Benfratelli Hospital
  • Andrea Taormina
    • Division of CardiologyBuccheri La Ferla Fatebenefratelli Hospital
  • Vincenzo Azzarello
    • Division of CardiologyBuccheri La Ferla Fatebenefratelli Hospital
  • Filippo Felice
    • Nuclear Cardiology ServiceCivico and Benfratelli Hospital
  • Annamaria Martino
    • Division of CardiologyBuccheri La Ferla Fatebenefratelli Hospital
  • Salvatore Paterna
    • Department of Internal MedicineUniversity of Palermo
  • Pietro Di Pasquale
    • Division of Cardiology “Paolo Borsellino”G.F. Ingrassia Hospital
Original Paper

DOI: 10.1007/s10554-006-9169-5

Cite this article as:
Sarullo, F.M., Ventimiglia, C., Taormina, A. et al. Int J Cardiovasc Imaging (2007) 23: 511. doi:10.1007/s10554-006-9169-5



Failure to reach 80% of maximal predicted heart rate (HR) during exercise may render a myocardial perfusion single photon emission computed tomography (SPECT) study non-diagnostic for ischemia detection. We sought to investigate the injection of atropine in patients who fail to achieve 80% of age-predicted HR during exercise performed for myocardial perfusion SPECT (MPS), defining its safety and efficacy to raise HR to adequate levels as well as its effect on MPS interpretation.

Methods and results

Between January 2002 and December 2004, we studied 3,150 consecutive patients (2,253 men and 897 women, mean age 55 ± 6 years) who were referred to a single office-based nuclear cardiology laboratory for MPS using SPECT imaging. One milligram of atropine was administered to patients that were unable to continue because of fatigue before reaching minimal HR, without an ischemic response (group A, = 397). The scintigraphic results for group A were compared with those of patients who spontaneously achieved target HR (group B, = 2,753). In group A, mean HR before atropine injection was 119.5 ± 13.6 beats per minute (bpm), and it increased up to 137.3 ± 13.5 bpm after drug administration, with an incremental of 17.8 ± 6.9 bpm (< 0.0001). The mean percentage of age-related HR achieved in this group was 83.5 ± 8.1%. In 302 of this patients (76.1%) more than 80% of their aged-related HR (86.9 ± 5.1%) was attained. No major adverse effects occurred. When groups A and B were compared, baseline and peak HR, rate pressure product, and maximal metabolic equivalents achieved were higher in group B. There were no significant differences in the percentage of total positive perfusion studies between both groups: 210/397 patients (52.9%) in group A and 1,342/2,753 patients (48.7%) in group B (= 0.39). Ischemia or ischemia plus scar was found in 112/397 patients (28.2%) in group A and in 923/2,753 patients (33.5%) of group B (= 0.14).


Atropine added to exercise stress testing in patients who cannot achieve their 80% age-related HR is a safe, well-tolerated, and feasible method for MPS.


AtropineExercise testingMyocardial perfusion SPECTMaximal predicted heart rate

Copyright information

© Springer Science+Business Media, Inc. 2006