Ramachandruni Srikanth, Fillingim Roger B, McGorray Susan P, Schmalfuss Carsten M, Cooper Gary R, Schofield Richard S, Sheps David S
University of Florida, Gainesville, Florida 32608, USA.
J Am Coll Cardiol. 2006 Mar 7;47(5):987-91. doi: 10.1016/j.jacc.2005.10.051. Epub 2006 Feb 9.
The purpose of this study was to investigate the possibility that some patients with coronary artery disease (CAD) but negative exercise or chemical stress test results might have mental stress-induced ischemia. The study population consisted solely of those with negative test results.
Mental stress-induced ischemia has been reported in 20% to 70% of CAD subjects with exercise-induced ischemia. Because mechanisms of exercise and mental stress-induced ischemia may differ, we studied whether mental stress would produce ischemia in a proportion of subjects with CAD who have no inducible ischemia with exercise or pharmacologic tests.
Twenty-one subjects (14 men, 7 women) with a mean age of 67 years and with a documented history of CAD were studied. All subjects had a recent negative nuclear stress test result (exercise or chemical). Subjects completed a speaking task involving role playing a difficult interpersonal situation. A total of 30 mCi 99mTc-sestamibi was injected at one minute into the speech, and imaging was started 40 min later. A resting image obtained within one week was compared with the stress image. Images were analyzed for number and severity of perfusion defects. The summed difference score based on the difference between summed stress and rest scores was calculated. Severity was assessed using a semiquantitative scoring method from zero to four.
Six of 21 (29%) subjects demonstrated reversible ischemia (summed difference score > or =3) with mental stress. No subject had chest pain or electrocardiographic changes during the stressor. Mean systolic and diastolic blood pressure and heart rate all increased between resting and times of peak stress.
Mental stress may produce ischemia in some subjects with CAD and negative exercise or chemical nuclear stress test results.
本研究旨在调查某些冠状动脉疾病（CAD）患者运动或化学应激试验结果为阴性但可能存在精神应激诱导性心肌缺血的可能性。研究人群仅包括试验结果为阴性的患者。
据报道，在20%至70%的运动诱导性心肌缺血的CAD患者中存在精神应激诱导性心肌缺血。由于运动和精神应激诱导性心肌缺血的机制可能不同，我们研究了精神应激是否会在一部分运动或药物试验无诱导性心肌缺血的CAD患者中导致心肌缺血。
对21名平均年龄67岁且有CAD病史记录的受试者（14名男性，7名女性）进行研究。所有受试者近期的核素应激试验结果（运动或化学试验）均为阴性。受试者完成一项涉及模拟困难人际情境角色扮演的说话任务。在说话开始1分钟时注射总计30mCi的99mTc- sestamibi，40分钟后开始成像。将一周内获得的静息图像与应激图像进行比较。分析图像的灌注缺损数量和严重程度。根据应激总分与静息总分的差值计算总差异评分。使用从0到4的半定量评分方法评估严重程度。
21名受试者中有6名（29%）在精神应激下出现可逆性心肌缺血（总差异评分≥3）。在应激过程中，没有受试者出现胸痛或心电图变化。静息状态与应激峰值时相比，平均收缩压、舒张压和心率均升高。
精神应激可能会在一些CAD患者中导致心肌缺血，这些患者运动或化学核素应激试验结果为阴性。
