title: Simultaneous assessment of myocardial perfusion and function during mental stress in patients with chronic coronary artery disease.
abstract: BACKGROUND
  Mental stress (MS) is an important provocateur of myocardial ischemia in many patients with chronic coronary artery disease. The majority of laboratory assessments of ischemia in response to MS have included measurements of either myocardial perfusion or function alone. We performed this study to determine the relationship between alterations in perfusion and ventricular function during MS. Methods and results Twenty-eight patients with reversible perfusion defects on exercise or pharmacologic stress myocardial perfusion imaging (MPI) underwent simultaneous technetium 99m sestamibi single photon emission computed tomography (SPECT) MPI and transthoracic echocardiography at rest and during MS according to a mental arithmetic protocol. In all cases the MS study was performed within 4 weeks of the initial exercise or pharmacologic MPI that demonstrated ischemia. SPECT studies were analyzed visually with the use of a 13-segment model and quantitatively by semiautomated circumferential profile analysis. Echocardiograms were graded on a segmental model for regional wall motion on a 4-point scale. Of 28 patients, 18 (64%) had perfusion defects and/or left ventricular dysfunction develop during MS: 9 (32%) had myocardial perfusion defects develop, 6 (21%) had regional or global left ventricular dysfunction develop, and 3 (11%) had both perfusion defects and left ventricular dysfunction develop. The overall concordance between perfusion and function criteria for ischemia during MS was only 46%. Among 9 patients with MS-induced left ventricular dysfunction, 5 had new regional wall motion abnormalities and 4 had a global decrement in function. In patients with MS-induced ischemia by SPECT, the number of reversible perfusion defects was similar during both MS and exercise/pharmacologic stress (2.8 +/- 2.0 vs 3.5 +/- 1.8, P =.41). Hemodynamic changes during MS were similar whether patients were divided on the basis of perfusion defects or left ventricular dysfunction during MS.
  
  
  CONCLUSIONS
  These data indicate the feasibility of simultaneous assessment of perfusion and function responses during MS. Flow and function responses to MS are frequently not concordant. These data suggest that MS-induced changes in perfusion may represent a different phenomenon than MS-induced changes in left ventricular function (either globally or regionally).
authors.affiliation: Section of Cardiovascular Medicine, Deparment of Medicine, Yale University School of Medicine, New Haven, CT 06516, USA. James.Arrighi@med.va.gov
authors.forename: James A
authors.initials: JA
authors.lastname: Arrighi
authors.forename: Matthew
authors.initials: M
authors.lastname: Burg
authors.forename: Ira S
authors.initials: IS
authors.lastname: Cohen
authors.forename: Robert
authors.initials: R
authors.lastname: Soufer
mesh_terms: D000368:Aged; D001794:Blood Pressure; D002908:Chronic Disease; D003326:Coronary Circulation / Q000502:physiology; D003327:Coronary Disease / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D004452:Echocardiography; D006801:Humans; D008297:Male; D008875:Middle Aged; D019275:Radiopharmaceuticals; D013315:Stress, Psychological / Q000150:complications / Q000503:physiopathology*; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000503:physiopathology
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi