Prognostic significance of ischemic electrocardiographic changes during vasodilator stress testing in patients with normal SPECT images

J Nucl Cardiol. Jan-Feb 2003;10(1):4-8. doi: 10.1067/mnc.2003.127624.


Background: Patients with ischemic electrocardiographic (ECG) findings during exercise stress testing but normal perfusion images generally have a low risk of cardiac death or myocardial infarction (<1% per year). During vasodilator stress testing, however, the prognostic significance of the combination of normal perfusion images and ischemic ECG changes is unknown.

Methods and results: Among 5526 patients who underwent vasodilator stress single photon emission computed tomography (SPECT), 49 (0.9%) had normal images but ischemic ECG changes. A unique feature of this population was that 43 (88%) were women with a mean age of 67 +/- 10 years. Ischemic ECG changes occurred at a mean heart rate of 101 +/- 15 beats per minute and persisted for 6.8 +/- 4.7 minutes after termination of drug infusion. During follow-up of 28 +/- 20 months, cardiac death occurred in 2 patients and nonfatal myocardial infarction in 4 patients. The rate of cardiac death or nonfatal myocardial infarction was 4% at 1 year, 10% at 2 years, and 14% at 3 years. Of the 12 patients who underwent coronary angiography or autopsy during follow-up, 11 had multivessel coronary artery disease, indicating that these patients likely had false-negative SPECT image results. Eight patients required coronary revascularization.

Conclusions: The finding of ischemic ECG changes with normal SPECT images during vasodilator infusion is uncommon, occurs primarily in older women, and is associated with a higher subsequent cardiac event rate than is customarily associated with normal images.

Publication types

  • Evaluation Study

MeSH terms

  • Adenosine
  • Aged
  • Coronary Disease / diagnosis
  • Coronary Disease / diagnostic imaging
  • Dipyridamole
  • Electrocardiography*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Myocardial Ischemia / diagnosis
  • Myocardial Ischemia / diagnostic imaging*
  • Prognosis
  • Radiopharmaceuticals
  • Risk Factors
  • Survival Analysis
  • Technetium Tc 99m Sestamibi
  • Thallium Radioisotopes
  • Tomography, Emission-Computed, Single-Photon*
  • Vasodilator Agents*


  • Radiopharmaceuticals
  • Thallium Radioisotopes
  • Vasodilator Agents
  • Dipyridamole
  • Technetium Tc 99m Sestamibi
  • Adenosine