| Detection and reproducibility of mental stress-induced myocardial ischemia with Tc-99m sestamibi SPECT in normal and coronary artery disease populations. | |
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MedLine Citation:
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PMID: 12569332 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Mental stress-induced ischemia, as detected by radionuclide studies, has yielded reversible ischemia in only 30% to 60% of patients with exercise-induced ischemia. Little is known about the reproducibility of myocardial perfusion imaging in detecting mental stress-induced ischemia. The purpose of this study was to further evaluate the occurrence and reproducibility of mental stress-induced ischemia in patients with coronary artery disease (CAD) and in normal control subjects with a low likelihood of CAD by using sestamibi single photon emission computed tomography (SPECT) imaging. METHODS AND RESULTS: A total of 40 patients were enrolled in this study: 19 patients with CAD and typical angina or reversible ischemia (positive exercise treadmill study or positive adenosine thallium study) and 21 normal control subjects underwent mental stress testing as well as myocardial perfusion imaging. The subjects were given a speaking task, and SPECT imaging was subsequently performed. Two experienced readers compared mental stress imaging with a resting image using a 20-segment cardiac model. Hemodynamic changes in blood pressure and heart rate with mental stress were also measured in all subjects. Each patient with CAD also underwent repeat mental stress testing and myocardial imaging approximately 2 weeks later. Of the 19 patients with CAD and typical angina or with evidence of reversible ischemia, 16 (84%) demonstrated ischemia with mental stress, as detected by sestamibi SPECT imaging. The mean number of new or worsened perfusion defects attributable to mental stress was 3.5, with a mean severity of 1.7. These results were also reproducible. With repeated mental stress testing and myocardial imaging, 12 of the 16 CAD patients (75%) demonstrated evidence of myocardial ischemia. None of the 21 normal control subjects had evidence of mental stress-induced myocardial ischemia. Mental stress also induced reproducible and significant hemodynamic changes in CAD patients. CONCLUSIONS: In patients with known CAD with typical angina or with evidence of reversible ischemia despite taking medications, mental stress was very effective in inducing myocardial ischemia, as detected by sestamibi SPECT imaging. Mental stress was also found to elicit significant hemodynamic responses. Furthermore, these findings demonstrated good reproducibility. |
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Authors:
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Chin K Kim; Beth A Bartholomew; Suzanne T Mastin; Vicente C Taasan; Kimberly M Carson; David S Sheps |
Publication Detail:
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Type: Evaluation Studies; Journal Article; Research Support, U.S. Gov't, Non-P.H.S.; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology Volume: 10 ISSN: 1071-3581 ISO Abbreviation: J Nucl Cardiol Publication Date: 2003 Jan-Feb |
Date Detail:
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Created Date: 2003-02-05 Completed Date: 2003-08-07 Revised Date: 2007-11-14 |
Medline Journal Info:
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Nlm Unique ID: 9423534 Medline TA: J Nucl Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 56-62 Citation Subset: IM |
Affiliation:
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Division of Cardiovascular Medicine, University of Florida, Gainesville, Fla, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Blood Pressure / physiology Coronary Disease / complications, radionuclide imaging Electrocardiography Exercise Test Female Humans Male Middle Aged Myocardial Ischemia / etiology, psychology, radionuclide imaging* Radiopharmaceuticals / diagnostic use Reproducibility of Results Severity of Illness Index Stress, Psychological / complications*, physiopathology Technetium Tc 99m Sestamibi / diagnostic use Tomography, Emission-Computed, Single-Photon |
| Grant Support | |
ID/Acronym/Agency:
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1-R29-HL-56825/HL/NHLBI NIH HHS; 2-R01-HL-47477/HL/NHLBI NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Radiopharmaceuticals; 109581-73-9/Technetium Tc 99m Sestamibi |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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