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

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

MedLine Citation:	PMID: 18674719 Owner: NLM Status: MEDLINE
Abstract/OtherAbstract:	BACKGROUND: Mental stress precipitates myocardial ischemia in a significant percentage of coronary artery disease (CAD) patients. Exercise or adenosine stresses produce different physiologic responses and cause myocardial ischemia via different mechanisms. Little is known about the comparative severity and location of myocardial ischemia provoked by these different stressors. In this study we sought to compare the within-individual ischemic responses to mental versus exercise or adenosine stress in a cohort of CAD patients. METHODS AND RESULTS: All patients underwent mental stress and either exercise or adenosine testing within a 1-week period. Mental stress was induced via a public speaking task. Rest-stress myocardial perfusion imaging was used with all testing protocols. Participants were 187 patients (65 women [35%]) with a documented history of CAD and a mean age of 64 +/- 9 years. Mental stress-induced myocardial ischemia (MSIMI) was less prevalent and frequently of less magnitude than exercise- or adenosine-induced ischemia. Ischemia induced by exercise or adenosine testing did not accurately predict the development or the location of MSIMI. The overall concordance between these stressors for provoking ischemia was weak (percent agreement, 71%; kappa [+/- SE], 0.26 +/- 0.07). In a minority of patients (11%) mental stress provoked ischemia in the absence of exercise- or adenosine-induced ischemia. Moreover, in patients who had myocardial ischemia during both stressors, there were significant within-individual differences in the coronary artery distribution of the ischemic regions. MSIMI was more likely to occur in a single-vessel distribution (86%) compared with exercise- or adenosine-induced ischemia (54%). The stressors had moderate agreement if the ischemic region was in the right coronary artery territory (percent agreement, 76%; kappa, 0.52 +/- 0.19) or the left anterior descending coronary artery (percent agreement, 76%; kappa, 0.51 +/- 0.19) and significantly lower agreement in the left circumflex territory (percent agreement, 62%; kappa, 0.22 +/- 0.18). CONCLUSIONS: Our findings indicate that mental and exercise or adenosine stresses provoke different myocardial ischemic responses. These observations suggest that exercise or adenosine testing may not adequately assess the likelihood of occurrence or severity of MSIMI and that different mechanisms are operative in each condition.

Authors:	Mustafa Hassan; Kaki M York; Qin Li; Dorian G Lucey; Roger B Fillingim; David S Sheps
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Publication Detail:	Type: Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, Non-P.H.S. Date: 2008-06-12
Journal Detail:	Title: Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology Volume: 15 ISSN: 1532-6551 ISO Abbreviation: J Nucl Cardiol Publication Date: 2008 Jul-Aug
Date Detail:	Created Date: 2008-08-04 Completed Date: 2008-11-18 Revised Date: 2009-11-18
Medline Journal Info:	Nlm Unique ID: 9423534 Medline TA: J Nucl Cardiol Country: United States
Other Details:	Languages: eng Pagination: 518-25 Citation Subset: IM
Affiliation:	Division of Cardiology, Department of Medicine, University of Florida, Gainesville, FL, USA. mustafa.hassan@medicine.ufl.edu
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MeSH Terms
Descriptor/Qualifier:	Adenosine / diagnostic use* Aged Causality Comorbidity Coronary Artery Disease / epidemiology, psychology, radionuclide imaging Exercise Test / statistics & numerical data* Female Florida / epidemiology Humans Incidence Male Myocardial Ischemia / epidemiology, psychology, radionuclide imaging Reproducibility of Results Sensitivity and Specificity Stress, Psychological / epidemiology, psychology, radionuclide imaging Vasodilator Agents / diagnostic use
Grant Support
ID/Acronym/Agency:	HL 070265/HL/NHLBI NIH HHS; HL 072059/HL/NHLBI NIH HHS; R01 HL070265-01A2/HL/NHLBI NIH HHS; R01 HL070265-02/HL/NHLBI NIH HHS; R01 HL070265-03/HL/NHLBI NIH HHS; R01 HL070265-04/HL/NHLBI NIH HHS; R01 HL070265-05/HL/NHLBI NIH HHS; R01 HL072059-01/HL/NHLBI NIH HHS; R01 HL072059-02/HL/NHLBI NIH HHS; R01 HL072059-02S1/HL/NHLBI NIH HHS; R01 HL072059-03/HL/NHLBI NIH HHS; R01 HL072059-04/HL/NHLBI NIH HHS; R01 HL072059-05/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:	0/Vasodilator Agents; 58-61-7/Adenosine
Comments/Corrections
Comment In:	J Nucl Cardiol. 2008 Jul-Aug;15(4):491-3 [PMID: 18674714 ]

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