Variability of myocardial ischemic responses to mental versus exercise or adenosine stress in patients with coronary artery disease

Hassan, Mustafa; York, Kaki M.; Qin, Li; Lucey, Dorian G.; Fillingim, Roger B.; Sheps, David S.

doi:10.1016/j.nuclcard.2008.04.005

Cited by 20 publications

(19 citation statements)

References 36 publications

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“…29,30 Interestingly, a recent study of CAD patients showed that mental stress provokes a different myocardial ischemic response compared to exercise or adenosine. 35 However, there is a little data available for patients groups with normal coronary arteries or syndrome X.…”

Section: Discussionmentioning

confidence: 99%

Association between anxiety disorder and the extent of ischemia observed in cardiac syndrome X

Vermeltfoort

Raijmakers

Odekerken

et al. 2009

Journal of Nuclear Cardiology

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Section: Discussionmentioning

confidence: 99%

Association between anxiety disorder and the extent of ischemia observed in cardiac syndrome X

Vermeltfoort

Raijmakers

Odekerken

et al. 2009

Journal of Nuclear Cardiology

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“…Its prognostic value is even more relevant, for in an analysis of 16 studies, with a total of 20,983 patients with normal radionuclide imaging and a mean follow-up of 28 months, a 0.7% rate of infarction or cardiac obit per year was observed, a value that is similar to the asymptomatic population 11 . Despite the excellent exactness of myocardial perfusion radionuclide imaging, some patients with established coronary disease 13 found a lower prevalence of ischemia during sensorial distress (19%), however, their criteria for ischemia were more rigid (SDS >4) than those of other studies 11 . Comparing the current study to the abovementioned ones, we observe that there is a higher prevalence of ischemia in our sample.…”

Section: Discussionmentioning

confidence: 90%

“…Previous studies demonstrate the difficulty in defining how patients respond to distress 2,13 . This limitation may be related to social factors or to natural alterations of the individual concerning his intrinsic capability of reacting to stress.…”

Section: Discussionmentioning

confidence: 99%

“…Comparing the current study to the abovementioned ones, we observe that there is a higher prevalence of ischemia in our sample. The reasons for such prevalence are: (1) only patients with thoracic pain were included in our study, while other authors included asymptomatic patients; (2) patients with previous DAC were not excluded; (3) a more sensitive criterion was employed for mental distress-induced ischemia (SDS ≥ 3), for even authors who employ more rigid criteria, like Hassan et al 13 , agree that lower limitations should be employed in clinical practice due to the less magnitude of mental distressinduced ischemia 11 .In patients with thoracic pain related to mental distress, the endothelial dysfunction seems to be the main present factor 14 . Epicardial vasoconstriction and microvascular dysfunction of the coronary artery have been suggested as basis mechanisms for sensorial distress-induced ischemia 15 .…”

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confidence: 99%

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Prevalência de isquemia induzida por estresse mental

Barbirato¹,

Felix²,

Azevedo³

et al. 2010

Arq. Bras. Cardiol.

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Background: The myocardial radionuclide imaging with mental distress seems to induce ischemia through a particular physiopathology when compared to radionuclide imaging with physical or pharmacological distress.Objective: To assess the prevalence of induced myocardial ischemia by mental distress in patients with thoracic pain and radionuclide imaging with normal conventional distress, with 99mTc-Sestamibi.Methods: Twenty-two patients were admitted with thoracic pain at emergency or were referred to the nuclear medicine service of our institution, where myocardial radionuclide imaging of distress or rest without ischemic alterations was carried out. The patients were, then, invited to go through an additional phase with mental distress induced by color conflict (Strop Color Test) with the objective of detecting myocardial ischemia. Two cardiologists and nuclear physicians performed the blind analysis of perfusional data and consequent quantification through Summed Difference Score (SDS), punctuating the segments that were altered after mental distress and comparing it to the rest period image. The presence of myocardial ischemia was considered if SDS ≥ 3.Results: The prevalence of mental distress-induced myocardial ischemia was 40% (9 positive patients). Among the 22 studied patients, there were no statistical differences with regard to the number of risk factors, mental distress-induced hemodynamic alterations, usage of medications, presented symptoms, presence or absence of coronary disease and variations of ejection fraction and final systolic volume of Gated SPECT. Researches that used echocardiogram and radioisotope ventriculography associated with mental distress showed that this is the responsible for alterations in ventricular function 5,6 . Studies that applied radionuclide imaging of myocardial perfusion during mental distress confirmed that the contraction alterations were induced by alterations in perfusion. Conclusion Prevalence of Induced Ischemia by Mental DistressThe necessity for myocardial ischemia diagnosis in patients with thoracic pain is extremely important for a better clinical handling, risk factor control and improvement of their life quality. In this decade, an acute syndrome, unleashed by mental distress and represented by thoracic pain, supraunevenness of ST segment at electrocardiogram, elevation of myocardial necrosis markers and peculiar alterations of myocardial contractility demonstrated in echocardiograph and ventriculograph findings, was described. The so called Takotsubo syndrome is characterized by a reduction in contractility of apical myocardial segments and hyper-contractility of basal segments of left ventricle 7 . Other IntroductionThe myocardial perfusion radionuclide imaging has been applied in medical practice as an important tool for the diagnosis of myocardial ischemia. Is value on such diagnosis has been widely studied, which allows its utilization in patients admitted in emergency units and ambulatories 1 . However, a group of patients may relate thoracic ...

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“…Among the most widely used exams, radionuclide imaging is the one that bespeaks the most its value in diagnostic and prognostic evaluation of patients with thoracic pain 1 . Despite the fact that a radionuclide myocardial perfusion imaging is frequently associated with a risk for adverse events lower than 1% per year 2 , some patients with coronary arterial disease only have manifestation of ischemia when submitted to non-conventional ischemia induction techniques, such as psychological stress 3 . While the basis for the induction mechanism for perfusion alteration of radionuclide imaging during physical activity with intravenous dipyridamole is coronary vasodilatation, psychological stress causes epicardial coronary and microvascular vasoconstriction in patients with endothelial dysfunction and/or arteriosclerosis 4 .…”

Section: Introductionmentioning

confidence: 99%