Abstract
Objective
A mild decrease in blood pressure and increase in heart rate (HR) are considered normal hemodynamic responses to dipyridamole. In this study, we tried to investigate HR response to dipyridamole and its predictors in patients undergoing gated myocardial perfusion single photon emission computed tomography (SPECT).
Methods
201 consecutive patients undergoing dipyridamole stress Tc99m-MIBI or Tl-201 gated myocardial perfusion SPECT were prospectively enrolled. Dipyridamole was infused over 4 min and radiopharmaceutical was injected 3 min after the end of infusion. A reduced heart rate response to dipyridamole considered if the HR ratio (peak HR/rest HR) was 1.20 or less. Stress (sLVEF), rest (rLVEF) left ventricular ejection fractions, stress and rest motion (SMS, RMS) and thickening scores (STS, RTS) were derived automatically by QGS. Summed stress score (SSS), summed rest score (SRS), and summed difference score (SDS) for myocardial perfusion were calculated. Patients were grouped according to HR response and groups were compared. A logistic regression analysis was used to determine independent predictors of reduced HR response.
Results
Reduced HR response was found in 78 % of patients. Patients with abnormal HR response were more frequently had a history of diabetes mellitus, chronic renal failure, and had lower high-density lipoprotein (HDL) levels. Peak HR, SSS, SRS, sLVEF and rLVEF were lower; rest HR, RTS, and the number of patients with ≤45 % sLVEF and rLVEF were higher in reduced HR response group (all p < 0.05). There was no difference between groups by means of gender, rest and peak systolic or diastolic tension, SDS, SMS, STS, RMS, history of hypertension, peripheral arterial disease, metabolic syndrome, coronary interventions, digoxin, calcium channel blocker or beta blocker usage. Multivariable logistic regression analysis demonstrated that the independent predictors of reduced HR response were HDL, rest HR and SSS. When HDL was removed from the model, chronic renal failure also emerged as an independent predictor.
Conclusion
Reduced HR response to dipyridamole is associated with ventricular dysfunction, cardiac autonomic neuropathy. Low HDL levels also seem to be related with reduced HR response.
Similar content being viewed by others
References
Henzlova MJ, Cerqueira MD, Hansen CL, Taillefer R, Yao SS. Stress protocols and tracers ASNC Imaging guidelines for nuclear cardiology procedures. http://www.asnc.org.
Johnston DL, Daley JR, Hodge DO, Hopfenspirger MR, Gibbons RJ. Hemodynamic responses and adverse effects associated with adenosine and dipyridamole pharmacologic stres testing: a comparison in 2000 patients. Mayo Clinic Proc. 1995;70:331–6.
Iskandrian AS, Verani MS, Heo J. Pharmacologic stres testing: mechanism of action, hemodynamic responses, and results in detection of coronary artery disease. J Nucl Cardiol. 1994;1:94–111.
Abidov A, Hachamovitch R, Hayes SW, Ng CK, Cohen I, Friedman JD, et al. Prognostic impact of hemodynamic response to adenosine in patients older than 55 years undergoing vasodilator stress myocardial perfusion study. Circulation. 2003;107:2894–9.
Bhateja R, Francis GS, Pothier CE, Lauer MS. Heart rate response during dipyridamole stress as a predictor of mortality in patients with normal myocardial perfusion and normal electrocardiograms. Am J Cardiol. 2005;95:1159–64.
Kim YH, Lee KH, Chang HJ, Lee EJ, Chung HW, Choi JY, et al. Depressed heart rate response to vasodilator stress for myocardial SPECT predicts mortality in patients after myocardial infarction. Int J Cardiovasc Imaging. 2006;22:663–70.
Mathur S, Shah AR, Ahlberg AW, Katten DM, Heller GV. Blunted heart rate response as a predictor of cardiac death in patients undergoing vasodilator stress technetium-99m sestamibi gated SPECT myocardial perfusion imaging. J Nucl Cardiol. 2010;17:617–24.
Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. American Heart Association; National Heart, Lung, and Blood Institute. Circulation. 2005;112:2735–52.
De Lorenzo A, Lima RS. Influence of chronic renal failure on the heart rate response to dipyridamole in patients undergoing myocardial perfusion SPECT. J Nucl Cardiol. 2008;15:193–200.
Hage FG, Perry G, Heo J, Iskandrian AE. Blunting of the heart rate response to adenosine and regadenoson in relation to hyperglycemia and the metabolic syndrome. Am J Cardiol. 2010;105:839–43.
Hage FG, Heo J, Franks B, Belardinelli L, Blackburn B, Wang W, et al. Differences in heart rate response to adenosine and regadenoson in patients with and without diabetes mellitus. Am Heart J. 2009;157:771–6.
Dhalla AK, Wong MY, Wang WQ, Biaggioni I, Belardinelli L. Tachycardia caused by A2A adenosine receptor agonists is mediated by direct sympathoexcitation in awake rats. J Pharmacol Exp Ther. 2006;316:695–702.
Lauer MS, Francis GS, Okin PM, Pashkow FJ, Snader CE, Marwick TH. Impaired chronotropic response to exercise stress testing as a predictor of mortality. JAMA. 1999;281:524–9.
Vashist A, Heller EN, Blum S, Brown EJ, Bhalodkar NC. Association of heart rate response with scan and left ventricular function on adenosine myocardial perfusion imaging. Am J Cardiol. 2002;89:174–7.
Venkataraman R, Hage FG, Dorfman TA, Heo J, Aqel RA, de Mattos AM, et al. Relation between heart rate response to adenosine and mortality in patients with end-stage renal disease. Am J Cardiol. 2009;103:1159–64.
Gordon T, Castelli WP, Hjortland MC, Kannel WB, Dawber TR. High density lipoprotein as a protective factor against coronary heart disease: the Framingham Study. Am J Med. 1977;62:707–14.
Maser RE, Pfiefer MA, Dorman JS, Kuller RH, Becker DJ, Orchard TJ. Diabetic autonomic neuropathy and cardiovascular risk. Arch Intern Med. 1990;150:1218–22.
Kempler P, Tesfaye S, Chaturvedi N, Stevens LK, Webb DJ, Eaton S, et al. Autonomic neuropathy is associated with increased cardiovascular risk factors: the EURODIAB IDDM Complications Study. Diabet Med. 2002;19:900–9.
Debono M, Cachia E. The impact of cardiovascular autonomic neuropathy in diabetes: is it associated with left ventricular dysfunction? Auton Neurosci. 2007;132:1–7.
Lahiri MK, Kannankeril PJ, Goldberger JJ. Assessment of autonomic function in cardiovascular disease: physiological basis and prognostic implications. J Am Coll Cardiol. 2008;51:1725–33.
Vita G, Bellinghieri G, Trusso A, Costantino G, Santoro D, Monteleone F, et al. Uremic autonomic neuropathy studied by spectral analysis of heart rate. Kidney Int. 1999;56:232–7.
Calvo C, Maule S, Mecca F, Quadri R, Martina G, Cavallo-Perin P. The influence of autonomic neuropathy on hypotension during hemodialysis. Clinic Auton Res. 2002;12:84–7.
Kurata C, Uehara A, Ishikawa A. Improvement of cardiac sympathetic innervation by renal transplantation. J Nucl Med. 2004;45:1114–20.
Marwick TH, Steinmuller DR, Underwood DA, Hobbs RE, Go RT, Swift C, et al. Ineffectiveness of dipyridamole SPECT thallium imaging as a screening technique for coronary artery disease in patients with end-stage renal failure. Transplantation. 1990;49:100–3.
Vandenberg BF, Rossen JD, Grover-McKay M, Shammas NW, Burns TL, Rezai K. Evaluation of diabetic patients for renal and pancreas transplantation: noninvasive screening for coronary artery disease using radionuclide methods. Transplantation. 1996;62:1230–5.
De Lorenzo A, Lima RS. Reduced heart rate response to dipyridamole as a marker of left ventricular dysfunction in diabetic patients undergoing myocardial perfusion scintigraphy. Clin Nucl Med. 2009;34:275–8.
de Souza Leão Lima R, Machado L, Azevedo AB, De Lorenzo A. Predictors of abnormal heart rate response to dipyridamole in patients undergoing myocardial perfusion SPECT. Ann Nucl Med. 2011;25:7–11.
Conflict of interest
No potential conflicts of interest were disclosed.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Gorur, G.D., Ciftci, E.A., Kozdag, G. et al. Reduced heart rate response to dipyridamole in patients undergoing myocardial perfusion SPECT. Ann Nucl Med 26, 609–615 (2012). https://doi.org/10.1007/s12149-012-0618-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12149-012-0618-z