Carney R M, McMahon R P, Freedland K E, Becker L, Krantz D S, Proschan M A, Raczynski J M, Ketterer M W, Knatterud G L, Light K, Lindholm L, Sheps D S
Washington University School of Medicine, St. Louis, Missouri 63178, USA.
Psychosom Med. 1998 Jan-Feb;60(1):64-70. doi: 10.1097/00006842-199801000-00015.
Many patients with coronary artery disease (CAD) develop myocardial ischemia in response to mental stress. This has been documented both in the natural environment and in the laboratory. However, the reproducibility of laboratory mental stress-induced ischemia has not been investigated.
Sixty patients with documented CAD and a positive exercise stress test discontinued cardiac medications and underwent two standardized mental stress tests (a timed Stroop Color-Word test and a public speaking task) in a nuclear cardiology laboratory (Visit 1), and repeated this procedure between 2 and 8 weeks later (Visit 2). Measurements of cardiovascular function and neurohormonal responses were obtained throughout testing, and mood state was assessed before and after testing.
Sixty-eight percent of the 56 patients with detailed radionuclide data from both visits had consistent responses (ie, ischemia either present during both sessions or absent during both) to the Stroop task (kappa = .29, p = .03), 61% had consistent responses to the speech task (kappa = .20, p = .12), and 60% had consistent responses when ischemia was considered present if it occurred during either the Stroop test, the speech task, or both, and absent if it did not occur during either task (kappa = .22, p = .07). Hemodynamic and neuroendocrine responses to the tests were moderately reproducible.
We conclude that two popular laboratory tests for mental stress-induced myocardial ischemia are modestly reproducible. The relatively low reproducibility is probably influenced by uncertainties in detecting relatively small changes in wall motion, habituation of the patient to repeated exposure to psychological stressors, and physiological differences in threshold for ischemia on different days of testing.
许多冠心病（CAD）患者在精神应激时会发生心肌缺血。这在自然环境和实验室中均有记录。然而，实验室精神应激诱发缺血的可重复性尚未得到研究。
60例有记录的CAD患者且运动应激试验阳性，停用心脏药物，在核心脏病学实验室接受两项标准化精神应激试验（定时Stroop色词试验和公开演讲任务）（第1次就诊），并在2至8周后重复此过程（第2次就诊）。在整个测试过程中获取心血管功能和神经激素反应的测量值，并在测试前后评估情绪状态。
在两次就诊均有详细放射性核素数据的56例患者中，68%对Stroop任务有一致反应（即两次检查期间均出现缺血或均未出现缺血）（kappa = 0.29，p = 0.03），61%对演讲任务有一致反应（kappa = 0.20，p = 0.12），60%在以下情况下有一致反应：如果在Stroop试验、演讲任务或两者中出现缺血则视为存在缺血，如果在两项任务中均未出现缺血则视为不存在缺血（kappa = 0.22，p = 0.07）。对测试的血流动力学和神经内分泌反应具有中度可重复性。
我们得出结论，两种常用的实验室精神应激诱发心肌缺血试验具有一定程度的可重复性。相对较低的可重复性可能受到检测壁运动相对小变化的不确定性、患者对反复暴露于心理应激源的习惯化以及不同测试日缺血阈值的生理差异的影响。
