title: Usefulness of peripheral arterial tonometry in the detection of mental stress-induced myocardial ischemia.
abstract: BACKGROUND
  Mental stress-induced myocardial ischemia (MSIMI) identifies a subset of coronary arterial disease (CAD) patients at increased risk for adverse cardiovascular events. Peripheral arterial vasoconstriction has been consistently reported as an underlying mechanism for ischemia development in this setting and as such affords a unique opportunity for the noninvasive detection of this phenomenon.
  
  
  OBJECTIVE
  We studied the usefulness of a peripheral arterial tonometry (PAT) technique in the detection of MSIMI. We sought to identify response patterns that would predict the development of MSIMI.
  
  
  METHODS
  Participants were 211 patients with documented CAD. Mental stress testing was performed using a public speaking task. Rest-stress myocardial perfusion imaging was the gold standard for ischemia detection. PAT responses were assessed during the 2 phases of the stressful task (stress anticipation and the task performance) and were calculated as a ratio of stress to the resting pulse wave amplitude.
  
  
  RESULTS
  Vascular response during the stress anticipation period (speech preparation) was more pronounced than during the actual speaking task (the mean preparation index was 0.64 +/- 0.53; the mean speech index was 0.72 +/- 0.60; P < 0.001). PAT response during speech preparation had modest accuracy for predicting MSIMI (area under the curve [AUC] was 0.63; 95% confidence interval [CI]: 0.53-0.74, P = 0.015). A PAT index < or = 0.52 was identified as the best cut off value for detecting MSIMI with a sensitivity of 76% and a specificity of 56%.
  
  
  CONCLUSIONS
  We identified a pattern of peripheral arterial response to mental stress that has a relatively modest accuracy in predicting MSIMI. Further research is needed to validate the findings of this study.
authors: Division of Cardiology, Department of Medicine, University of Florida, Gainesville, Florida, USA. mustafa.hassan@medicine.ufl.edu
authors: Mustafa
authors: M
authors: Hassan
authors: Kaki M
authors: KM
authors: York
authors: Haihong
authors: H
authors: Li
authors: Qin
authors: Q
authors: Li
authors: Dorian G
authors: DG
authors: Lucey
authors: Roger B
authors: RB
authors: Fillingim
authors: David S
authors: DS
authors: Sheps
mesh_terms: D000368:Aged; D001158:Arteries / Q000503:physiopathology; D001794:Blood Pressure; D003324:Coronary Artery Disease / Q000150:complications* / Q000503:physiopathology; D005260:Female; D005385:Fingers / Q000098:blood supply*; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D055414:Myocardial Perfusion Imaging / Q000379:methods; D011237:Predictive Value of Tests; D011673:Pulsatile Flow; D012372:ROC Curve; D012039:Regional Blood Flow; D012680:Sensitivity and Specificity; D013060:Speech; D013315:Stress, Psychological / Q000150:complications* / Q000503:physiopathology; D015899:Tomography, Emission-Computed, Single-Photon; D014661:Vasoconstriction