Prevalence of induced ischemia by mental distress.
BACKGROUND
The myocardial radionuclide imaging with mental distress seems to induce ischemia through a particular physiopathology when compared to radionuclide imaging with physical or pharmacological distress.


OBJECTIVE
To assess the prevalence of induced myocardial ischemia by mental distress in patients with thoracic pain and radionuclide imaging with normal conventional distress, with 99mTc-Sestamibi.


METHODS
Twenty-two patients were admitted with thoracic pain at emergency or were referred to the nuclear medicine service of our institution, where myocardial radionuclide imaging of distress or rest without ischemic alterations was carried out. The patients were, then, invited to go through an additional phase with mental distress induced by color conflict (Strop Color Test) with the objective of detecting myocardial ischemia. Two cardiologists and nuclear physicians performed the blind analysis of perfusional data and consequent quantification through Summed Difference Score (SDS), punctuating the segments that were altered after mental distress and comparing it to the rest period image. The presence of myocardial ischemia was considered if SDS > or = 3.


RESULTS
The prevalence of mental distress-induced myocardial ischemia was 40% (9 positive patients). Among the 22 studied patients, there were no statistical differences with regard to the number of risk factors, mental distress-induced hemodynamic alterations, usage of medications, presented symptoms, presence or absence of coronary disease and variations of ejection fraction and final systolic volume of Gated SPECT.


CONCLUSIONS
In a selected sample of patients with thoracic pain and normal myocardial radionuclide imaging, the research of myocardial ischemia induced by mental distress through radionuclide imaging may be positive in up to 40% of cases.
Barbirato
Gustavo Borges
GB
Hospital Universitário Antonio Pedro, Universidade Federal Fluminense, Rio de Janeiro, RJ - Brazil. gbarbirato@cardiol.br
Félix
Renata
R
de Azevedo
Jader Cunha
JC
Corrêa
Patrícia Lavatori
PL
de Nóbrega
Antônio Claudio Lucas
AC
Coimbra
Alexandro
A
Volschan
André
A
Mesquita
Evandro Tinoco
ET
Dohmann
Hans Fernando Rocha
HF
Mesquita
Cláudio Tinoco
CT
D000328:Adult; D017677:Age Distribution; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D001938:Brazil / Q000453:epidemiology; D002637:Chest Pain / Q000150:complications* / Q000000981:diagnostic imaging; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D015995:Prevalence; D011877:Radionuclide Imaging; D012307:Risk Factors; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D013312:Stress, Physiological / Q000502:physiology; D013315:Stress, Psychological / Q000150:complications*