Addition of atropine to submaximal exercise stress testing in patients evaluated for suspected ischaemia with SPECT imaging: a randomized, placebo-controlled trial

  • Fiore Manganelli
  • Marco Spadafora
  • Paola Varrella
  • Giuseppina Peluso
  • Rosario Sauro
  • Emilio Di Lorenzo
  • Giuseppe Rosato
  • Stefania Daniele
  • Alberto CuocoloEmail author
Original Article



To evaluate the effects of the addition of atropine to exercise testing in patients who failed to achieve their target heart rate (HR) during stress myocardial perfusion imaging with single-photon emission computed tomography (SPECT).


The study was a prospective, randomized, placebo-controlled design. Patients with suspected or known coronary artery disease who failed to achieve a target HR (≥85% of maximal predicted HR) during exercise SPECT imaging were randomized to receive intravenous atropine (n = 100) or placebo (n = 101).


The two groups of patients did not differ with respect to demographic or clinical characteristics. A higher proportion of patients in the atropine group achieved the target HR compared to the placebo group (60% versus 3%, p < 0.0001). SPECT imaging was abnormal in a higher proportion of patients in the atropine group as compared to the placebo group (57% versus 42%, p < 0.05). Stress-induced myocardial ischaemia was present in more patients in the atropine group as compared to placebo (47% versus 29%, p < 0.01). In both groups of patients, no major side effects occurred.


The addition of atropine at the end of exercise testing is more effective than placebo in raising HR to adequate levels, without additional risks of complications. The use of atropine in patients who initially failed to achieve their maximal predicted HR is associated with a higher probability of achieving a diagnostic myocardial perfusion study.


Exercise stress testing Atropine Myocardial perfusion imaging 


Conflicts of interest



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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Fiore Manganelli
    • 1
  • Marco Spadafora
    • 2
  • Paola Varrella
    • 2
  • Giuseppina Peluso
    • 2
  • Rosario Sauro
    • 1
  • Emilio Di Lorenzo
    • 1
  • Giuseppe Rosato
    • 1
  • Stefania Daniele
    • 3
  • Alberto Cuocolo
    • 3
    • 4
    • 5
    Email author
  1. 1.Department of Cardiology and Heart SurgerySan Giuseppe Moscati HospitalAvellinoItaly
  2. 2.Nuclear Medicine UnitSan Giuseppe Moscati HospitalAvellinoItaly
  3. 3.Institute of Diagnostic and Nuclear Development (SDN)NaplesItaly
  4. 4.Department of Biomorphological and Functional SciencesUniversity Federico IINaplesItaly
  5. 5.Institute of Biostructures and BioimagesNational Council of ResearchNaplesItaly

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