Correlation Between Dipyridamole-Induced Electrocardiogram Arrhythmia and Risk Stratification in Myocardial Perfusion SPECT Imaging

Document Type : Original Article


1 Hazrat Rasoul Akram Hospital, Department of Cardiology, Iran University of Medical Sciences, Tehran, IR Iran.

2 Department of Nuclear Medicine, School of Medicine, Rajaie Cardiovascular, Medical and Research Centre, Iran University of Medical Sciences, Tehran, IR Iran.

3 Hazrat Rasoul Akram Hospital, Department of Nuclear Medicine, Iran University of Medical Sciences, Tehran, IR Iran.


Background: Dipyridamole is administered as a substitute for physical activity during myocardial perfusion imaging (MPI). The purpose of this work was to evaluate the correlation between any kind of electrocardiogram (ECG) arrhythmia induced by dipyridamole and MPI findings in single-photon emission computed tomography (SPECT) imaging.
Methods: This study included 759 patients referred to the Nuclear Medicine Department of Hazrat Rasoul Akram Hospital. The study population underwent the dipyridamole MPI SPECT protocol. ECG for all the patients before and during dipyridamole infusion was obtained and assessed by cardiologists. All the patients underwent stress-rest technetium (99mTc) sestamibi-gated SPECT imaging using a 2D protocol.
Results: ST depression and ST elevation were observed in 69 (9.1%) and 23 (3%) patients, respectively, which had significant relationships with the moderate/high-risk stratification outcomes of MPI. Atrioventricular block, premature ventricular contractions, paroxysmal supraventricular tachycardia, bradyarrhythmia, and tachycardia showed no significant associations with moderate or high levels of risk stratification in MPI, and they were seen in 34 (4.5%), 34 (4.5%), 24 (3.2%), 16 (2.1%), and 39 (5.1%) patients, respectively.
Conclusions: High-risk MPI scan patterns had a significant correlation with ST depression and a relatively appraisable correlation with ST elevation in dipyridamole-induced ECG arrhythmia. (Iranian Heart Journal 2022; 23(3): 108-113)


  1. Rafla S, Abdel-Aaty A, Lotfy M, Gamal R. The Effect of Long Term Smoking as an Independent Coronary Risk Factor on Myocardial Perfusion Detected by Thallium 201 or Tc99m Sestamibi Spect Study. J Clin Exp Cardiolog. 2018; 9(589):2.
  2. Ho K-T, Miller TD, Christian TF, Hodge DO, Gibbons RJ. Prediction of severe coronary artery disease and long-term outcome in patients undergoing vasodilator SPECT. Journal of Nuclear Cardiology. 2001; 8(4):438-44.
  3. Malek H, Hedayati R, Yaghoobi N, Firoozabadi H, Rastgou F, Bitarafan Rajabi A. Association Between Blunted Heart Rate Response to Dipyridamole and Myocardial Ischemia in Diabetic Patients as Compared With Nondiabetic Patients. Iranian Heart Journal. 2020; 21(1):67-74.
  4. Regina S. Druz. Current Advances in Vasodilator Pharmacological Stress Perfusion Imaging,. Seminars in Nuclear Medicine,. 2009; Volume 39, ( Issue 3):204-9.
  5. Malek H, Hedayati R, Yaghoobi N, Behnia M, Rastgou F, Bitarafan Rajabi A, et al. The relationship between retinopathy in diabetes mellitus type 2 and severity and extent of myocardial ischemia in myocardial perfusion imaging. Iranian Heart Journal. 2013; 13(4):6-14.
  6. Klodas E, Miller TD, Christian TF, Hodge DO, Gibbons RJ. Prognostic significance of ischemic electrocardiographic changes during vasodilator stress testing in patients with normal SPECT images. Journal of Nuclear Cardiology. 2003; 10(1):4-8.
  7. Bitarafan-Rajabi A, Rastgou F, Hosseini S, Firoozabadi H, Malek H, Amouzadeh H, et al. Assessment of myocardial viability in patients with left ventricular dysfunction: Correlation between CT-based attenuation correction and uncorrected quantification analysis in thallium201 (201Tl) rest-redistribution SPECT study. Iranian Heart Journal. 2013:15-20.
  8. Henzlova MJ, Duvall WL, Einstein AJ, Travin MI, Verberne HJ. ASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers. J Nucl Cardiol. 2016; 23(3):606-39.
  9. Hevia JC, Antzelevitch C, Bárzaga FT, Sánchez MD, Balea FD, Molina RZ, et al. Tpeak-Tend and Tpeak-Tend dispersion as risk factors for ventricular tachycardia/ventricular fibrillation in patients with the Brugada syndrome. Journal of the American College of Cardiology. 2006; 47(9):1828-34.
  10. Fletcher GF, Balady GJ, Amsterdam EA, Chaitman B, Eckel R, Fleg J, et al. Exercise standards for testing and training: a statement for healthcare professionals from the American Heart Association. Circulation. 2001; 104(14):1694-740.
  11. Beller GA BK, Hendel RC, Shaw LJ, Williams KA. Unresolved issues in risk stratification: Chronic coronary artery disease including preoperative testing. J Nucl Cardiol 1997; 4:92-5.
  12. Jneid H, Anderson JL, Wright RS, Adams CD, Bridges CR, Casey DE, et al. 2012 ACCF/AHA focused update of the guideline for the management of patients with unstable angina/non–ST-elevation myocardial infarction (updating the 2007 guideline and replacing the 2011 focused update): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology. 2012; 60(7):645-81.
  13. Hachamovitch R, Berman DS, Shaw LJ, Kiat H, Cohen I, Cabico JA, et al. Incremental prognostic value of myocardial perfusion single photon emission computed tomography for the prediction of cardiac death: differential stratification for risk of cardiac death and myocardial infarction. Circulation. 1998; 97(6):535-43.
  14. Weinmann P, Moretti J-LJJoNC. Effects of dipyridamole on left ventricular function. 2000; 7(2):103-6.
  15. Mut F, Berettta M, Vidal I, Rener A, Alonso O, Nunez M, et al. Identification of myocardial stunning by means of gated perfusion SPECT in patients undergoing ischaemic stress myocardial tests. 2003; 2(2):122-5.
  16. DABAGH KV, Jabari H. Dipyridamole stress and rest gated 99m Tc-Sestamibi myocardial perfusion SPECT: left ventricular function indices and myocardial perfusion findings. 2007.
  17. Abbott BG, Afshar M, Berger AK, Frans J. Prognostic significance of ischemic electrocardiographic changes during adenosine infusion in patients with normal myocardial perfusion imaging. Journal of nuclear cardiology. 2003; 10(1):9-16.
  18. Villanueva FS, Smith WH, Watson DD, Beller GAJTAjoc. ST-segment depression during dipyridamole infusion, and its clinical, scintigraphic and hemodynamic correlates. 1992; 69(5):445-8.