title: Angina pectoris during daily activities and exercise stress testing: The role of inducible myocardial ischemia and psychological distress.
abstract: Physicians often consider angina pectoris to be synonymous with myocardial ischemia. However, the relationship between angina and myocardial ischemia is highly variable and we have little insight into the sources of this variability. We investigated the relationship of inducible myocardial ischemia on SPECT stress perfusion imaging to angina reported with routine daily activities during the previous four weeks (N=788) and to angina reported during an exercise stress test (N=371) in individuals with confirmed or suspected coronary disease referred for clinical testing. We found that angina experienced during daily life is more strongly and consistently associated with psychological distress and the personal threat associated with angina than with inducible myocardial ischemia. In multivariable models, the presence of any angina during routine activities over the prior month was significantly associated with age, perceived risk of myocardial infarction, and anxiety when compared to those with no reported angina in the past month. Angina during daily life was not significantly associated with inducible myocardial ischemia on stress perfusion imaging in bivariate or multivariable models. In contrast, angina experienced during exercise stress testing was significantly related to image and ECG ischemia, though it was also significantly associated with anxiety. These results suggest that angina frequency over the previous four weeks is more strongly associated with personal threat and psychosocial distress than with inducible myocardial ischemia. These results lend support to angina treatment strategies that aim to reduce threat and distress as well as to reduce myocardial ischemia.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Division of Consultation-Liaison Psychiatry, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560, Seattle, WA 98195-6560, USA Mid American Heart Institute, University of Missouri, Kansas City, MO, USA Department of Cardiology, VA Puget Sound Health Care System, Seattle, WA, USA Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA Department of Radiology, University of Washington, Seattle, WA, USA.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Sullivan
authors.forename: Paul S
authors.initials: PS
authors.lastname: Ciechanowski
authors.forename: Joan E
authors.initials: JE
authors.lastname: Russo
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.forename: Laurie A
authors.initials: LA
authors.lastname: Soine
authors.forename: Kier
authors.initials: K
authors.lastname: Jordan-Keith
authors.forename: James H
authors.initials: JH
authors.lastname: Caldwell
mesh_terms: D000203:Activities of Daily Living; D000342:Affective Symptoms / Q000150:complications / Q000503:physiopathology; D000367:Age Factors; D000787:Angina Pectoris / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D001007:Anxiety / Q000150:complications* / Q000503:physiopathology; D005080:Exercise Test; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery / Q000628:therapy; D017202:Myocardial Ischemia / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D012008:Recurrence; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D013315:Stress, Psychological / Q000150:complications* / Q000503:physiopathology; D015899:Tomography, Emission-Computed, Single-Photon