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Predictors of abnormal heart rate response to dipyridamole in patients undergoing myocardial perfusion SPECT

Annals of Nuclear Medicine volume 25, pages 7–11 (2011)Cite this article

Abstract

Objective

To identify predictors of abnormal HR response to dipyridamole (DIP) in patients undergoing myocardial perfusion SPECT (MPS).

Background

Patients with a reduced heart rate (HR) response to DIP have higher cardiac mortality, but the mechanism is unknown.

Methods

We studied 432 patients who underwent dual-isotope gated MPS. DIP (0.56 mg/kg) was infused over 4 min, and Tc-99m tetrofosmin was injected 3 min after the end of the infusion. MPS was semiquantitatively interpreted. Left ventricular ejection fraction (LVEF) and volumes were automatically calculated. The population was categorized into quartiles according to HR ratio, and characteristics in each quartile were compared. Logistic regression analysis was performed to identify predictors of abnormal HR response, using the lowest quartile as the independent variable.

Results

Patients with abnormal HR response were more frequently without chest pain, with a history of chronic renal failure and taking digoxin. Baseline HR was higher and had fewer symptoms during stress. The stress and rest perfusion defects were greater, but reversibility was not; in addition, LVEF was lower. Multivariable logistic regression analysis demonstrated that the independent predictors of abnormal HR response were baseline HR and low LVEF.

Conclusions

LV dysfunction is an independent predictor of abnormal HR response to DIP, and the association between low LVEF and low HR ratio may explain the link between abnormal HR ratio and increased mortality.

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Acknowledgments

The authors, individually or as a group, have/has no conflict of interest to state or disclosure to make regarding any commercial association that might pose a conflict of interest in connection with the submitted article.

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Affiliations

  1. Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil

    Ronaldo de Souza Leão Lima, Luis Machado & Alexandre B. Azevedo

  2. Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil

    Andrea De Lorenzo

  3. Rua Rui Vaz Pinto, 220/301, Ilha do Governador, Rio de Janeiro, RJ, 21931-390, Brazil

    Ronaldo de Souza Leão Lima

Authors
  1. Ronaldo de Souza Leão Lima
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  2. Luis Machado
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  3. Alexandre B. Azevedo
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  4. Andrea De Lorenzo
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Correspondence to Ronaldo de Souza Leão Lima.

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de Souza Leão Lima, R., Machado, L., Azevedo, A.B. et al. Predictors of abnormal heart rate response to dipyridamole in patients undergoing myocardial perfusion SPECT. Ann Nucl Med 25, 7–11 (2011). https://doi.org/10.1007/s12149-010-0420-8

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  • DOI: https://doi.org/10.1007/s12149-010-0420-8

Keywords

  • Myocardial perfusion SPECT
  • Heart rate
  • Dipyridamole