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Blunted heart rate response during dipyridamole stress SPECT is associated with cardiovascular outcomes in an

Alexander Izhaki1, Aviram Akuka2,3, Alexey Migranov1

  • 1Heart Institute, Edith Wolfson Medical Center, 62 Halochamim Street, Holon, 5810001, Israel.

BMC Cardiovascular Disorders
|June 24, 2026
PubMed

Insights

Blunted heart rate response (BHRR) during dipyridamole stress cardiac 99mTc-SPECT (DS-SPECT) is linked to increased cardiovascular death. Combining BHRR with abnormal DS-SPECT imaging further elevates risks for cardiovascular morbidity and all-cause mortality.

Area of Science:

  • Cardiology
  • Nuclear Medicine
  • Diagnostic Imaging

Background:

  • Dipyridamole stress cardiac 99mTc-SPECT (DS-SPECT) is a standard tool for diagnosing myocardial ischemia.
  • Blunted heart rate response (BHRR) during pharmacologic stress is a potential indicator of adverse cardiovascular outcomes.
  • The clinical significance of BHRR in unselected real-world DS-SPECT cohorts remains to be fully elucidated.

Purpose of the Study:

  • To evaluate the prognostic significance of BHRR in patients undergoing DS-SPECT.
  • To compare the predictive value of BHRR with conventional DS-SPECT imaging findings.
  • To assess the combined impact of BHRR and abnormal imaging on cardiovascular outcomes.

Main Methods:

  • A retrospective cohort study included adult patients who underwent DS-SPECT between 2014 and 2017.
  • Clinical data were extracted from electronic medical records and pre-test interviews.
  • Patients were followed up for cardiovascular events and mortality through September 2020.

Main Results:

  • The study included 388 patients; 63.1% exhibited BHRR.
  • BHRR was independently associated with an 8-fold increased risk of cardiovascular death (HR 8.09, p<0.05).
  • Patients with both abnormal DS-SPECT imaging and BHRR had a nearly fourfold increased risk of adverse cardiovascular events (HR 3.79, p<0.05) and the highest all-cause mortality (HR 2.93, p<0.01).

Conclusions:

  • BHRR in patients undergoing DS-SPECT is significantly associated with cardiovascular mortality.
  • The combination of BHRR and abnormal DS-SPECT findings substantially increases the risk of cardiovascular morbidity and all-cause mortality.
  • BHRR should be considered as a valuable prognostic marker in DS-SPECT assessments.
Abstract

Keywords:
Blunted heart rate responseDipyridamoleIschemic heart diseaseSPECT

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