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Mental stress-induced myocardial ischemia in coronary artery disease patients with left ventricular dysfunction

Mustafa Hassan1, Kaki M York, Haihong Li

  • 1Cardiovascular Research, Division of Cardiology, Department of Medicine, University of Florida, Gainesville, FL, USA. mustafa.hassan@medicine.ufl.edu

Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology
|June 9, 2007
PubMed

Insights

Patients with coronary artery disease (CAD) and reduced left ventricular ejection fraction (LVEF) are equally susceptible to mental stress-induced myocardial ischemia (MSIMI) as those with normal LVEF. This finding is crucial for understanding cardiovascular event risk.

Area of Science:

  • Cardiology
  • Nuclear Cardiology
  • Cardiovascular Imaging

Background:

  • Reduced left ventricular ejection fraction (LVEF) is a known risk factor for adverse outcomes in patients with coronary artery disease (CAD).
  • Mental stress-induced myocardial ischemia (MSIMI) identifies a high-risk subset of CAD patients.
  • The susceptibility of CAD patients with reduced LVEF to MSIMI remains uninvestigated.

Purpose of the Study:

  • To determine if patients with coronary artery disease (CAD) and reduced left ventricular ejection fraction (LVEF) exhibit different susceptibility to mental stress-induced myocardial ischemia (MSIMI) compared to those with normal LVEF.

Main Methods:

  • 182 patients with documented CAD underwent assessment of resting LVEF using technetium 99m sestamibi gated single-photon emission computed tomography.
  • Abnormal LVEF was defined as <45% for men and <50% for women.
  • Mental stress testing (public speaking task) and rest/stress myocardial perfusion SPECT were performed to assess for MSIMI, with a summed difference score >3 considered abnormal.

Main Results:

  • MSIMI occurred in 19% of patients with normal LVEF and 31% of patients with reduced LVEF.
  • No statistically significant difference in MSIMI susceptibility was observed between the normal and reduced LVEF groups (P = .11).

Conclusions:

  • Coronary artery disease patients with left ventricular dysfunction are similarly susceptible to mental stress-induced myocardial ischemia as those with preserved ejection fraction.
Abstract

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