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Purpose: The ST-segment depression occurring only in the recovery phase (↓STr) is relatively rare and occurs in 1-3% of the exercise testing (ET). The diagnostic and prognostic value is less investigated as compared with that observed during exercise. Only few studies have investigated the clinical significance of this finding. Objective: The aim of this study was evaluate the association between the ↓STr of the ET with the gated-SPECT imaging alterations. Methods: We analyzed 92 patients with ↓STr (≥ 1 mm), who underwent gated-SPECT associated with ET and Bruce protocol, mean age 60±9.9 years, 74 (80.4%) male, with previous coronary artery bypass graft in 20%, myocardial infarction in 25%, and percutaneous coronary intervention in 35.2%. Qualitative analysis of imaging used 5-point score (0-normal; 4-no uptake) for perfusion (17 myocardial segments), and 6-point score (0-normal; 5-diskinesia) for motility. Left ventricular ejection fraction (LVEF) was assessed after ET. ↓STr, blood pressure (BP), heart rate (HR), time of tolerance to exercise (TTE), functional capacity (MET), appearance time to ↓STr (AT↓STr), and presence of arrhythmias were evaluated during ET. Results: Abnormal perfusion was observed in 58 patients (63.04%), 50% with isolated ischemia or associated with persistent defect; abnormal motility in 31 patients (33.7%) and mean LVEF of 57.8±11.6%. AT↓STr 202±38 sec, magnitude of ↓STr 1.2±0.3 mm, 10.4±2.7 MET; angina in 16pts (17.6%) and ventricular arrhythmias in 58 pts (63%). There were significant differences in the association between perfusion alterations with: male p = 0.000, positive predictive value (PPV) 73%; AT↓STr p = 0.011, PPV 76.2%; increase in systolic blood pressure ≤ 30mmHg during ET p = 0.002, PPV 91.3%; and typical angina p = 0.025, PPV 87.5%. In patients with only transient defect, there were significant differences for male (p = 0.01), hypertension (p = 0.04) and marginal significance when systolic blood pressure ≤ 30mmHg (p = 0.09). The PPV of ↓STr to any perfusion, motility or LVEF alteration was 64%. Conclusion: ↓STr of the ET occurred late, and was a relevant finding due to the high incidence of documented alterations in the gated-SPECT.