Kim Chin K, Bartholomew Beth A, Mastin Suzanne T, Taasan Vicente C, Carson Kimberly M, Sheps David S
Division of Cardiovascular Medicine, University of Florida, Gainesville, Fla, USA.
J Nucl Cardiol. 2003 Jan-Feb;10(1):56-62. doi: 10.1067/mnc.2003.26.
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.
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.
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.
通过放射性核素研究检测到的精神应激诱发的缺血，在运动诱发缺血的患者中仅30%至60%出现可逆性缺血。关于心肌灌注成像检测精神应激诱发缺血的可重复性知之甚少。本研究的目的是通过使用锝-甲氧基异丁基异腈单光子发射计算机断层扫描（SPECT）成像，进一步评估冠状动脉疾病（CAD）患者和CAD可能性低的正常对照受试者中精神应激诱发缺血的发生情况和可重复性。
本研究共纳入40例患者：19例患有CAD且有典型心绞痛或可逆性缺血（运动平板试验阳性或腺苷铊试验阳性）的患者和21例正常对照受试者接受了精神应激测试以及心肌灌注成像。受试者被给予一项说话任务，随后进行SPECT成像。两位经验丰富的阅片者使用20节段心脏模型将精神应激成像与静息图像进行比较。还测量了所有受试者精神应激时血压和心率的血流动力学变化。每位CAD患者在大约2周后还接受了重复的精神应激测试和心肌成像。在19例患有CAD且有典型心绞痛或有可逆性缺血证据的患者中，16例（84%）通过锝-甲氧基异丁基异腈SPECT成像检测到精神应激时出现缺血。精神应激导致的新的或加重的灌注缺损平均数为3.5，平均严重程度为1.7。这些结果也是可重复的。通过重复的精神应激测试和心肌成像，16例CAD患者中的12例（75%）显示有心肌缺血证据。21例正常对照受试者中无一例有精神应激诱发心肌缺血的证据。精神应激在CAD患者中也诱发了可重复的显著血流动力学变化。
在已知患有CAD且有典型心绞痛或尽管服用药物仍有可逆性缺血证据的患者中，精神应激在诱发心肌缺血方面非常有效，这通过锝-甲氧基异丁基异腈SPECT成像检测到。还发现精神应激会引发显著的血流动力学反应。此外，这些发现显示出良好的可重复性。
