title: A study of myocardial perfusion in patients with panic disorder and low risk coronary artery disease after 35% CO2 challenge.
abstract: BACKGROUND
  We have previously reported that 35% CO2 challenge induced myocardial ischemia in 81% of coronary artery disease (CAD) patients with comorbid panic disorder (PD) and previous positive nuclear exercise stress tests. However, it is yet unclear whether this is the case among CAD patients with PD and normal nuclear exercise stress test results. We hypothesized that a potent mental stressor such as a panic challenge among CAD patients with PD would also induce ischemia in patients with normal exercise stress tests.
  
  
  METHODS
  Forty-one coronary artery disease patients with normal nuclear exercise stress tests (21 patients with PD and 20 without PD) were submitted to a well-established panic challenge test (with 1 vital capacity inhalation of a gas mixture containing 35% CO2 and 65% O2) and injected with Tc-99m-tetrofosmin (Myoview), upon inhalation. Single photon emission computed tomography imaging was used to assess per-panic challenge reversible myocardial ischemia and HR, BP, and a 12 lead ECG was continuously measured during the procedure.
  
  
  RESULTS
  Fifty-eight percent of panic disorder patients (12/21) had a panic attack during the panic challenge vs 15% (3/20) of controls (p=0.005). Only 10% of patients in each group displayed myocardial ischemia per panic challenge.
  
  
  CONCLUSIONS
  These findings suggest that panic attacks among panic disorder patients with lower-risk coronary artery disease may not confer a risk for myocardial ischemia.
authors.affiliation: Department of Family Medicine Emergency Medicine, Université Laval, Quebec, Canada; Research Chair in Emergency Medicine, Université Laval-Hôtel-Dieu de Lévis, Quebec, Canada. Electronic address: rfleet@videotron.ca.
authors.forename: Richard
authors.initials: R
authors.lastname: Fleet
authors.affiliation: Research Chair in Emergency Medicine, Université Laval-Hôtel-Dieu de Lévis, Quebec, Canada; School of Psychology, Université Laval, Quebec, Canada.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Foldes-Busque
authors.affiliation: School of Psychology, Université Laval, Quebec, Canada; Research Centre, Montreal Heart Institute, affiliated with Université de Montréal, Montreal, Canada; Nuclear Medicine Service, Montreal Heart Institute, Montreal, Canada.
authors.forename: Jean
authors.initials: J
authors.lastname: Grégoire
authors.affiliation: Research Centre, Montreal Heart Institute, affiliated with Université de Montréal, Montreal, Canada; Nuclear Medicine Service, Montreal Heart Institute, Montreal, Canada.
authors.forename: François
authors.initials: F
authors.lastname: Harel
authors.affiliation: Department of Medicine, Montreal Heart Institute, Montreal, Canada; Montreal Behavioural Medicine Centre, Research Centre, Department of Chest Medicine, Hôpital du Sacré-Cœur de Montréal, affiliated with Université de Montréal, Montreal, Canada.
authors.forename: Catherine
authors.initials: C
authors.lastname: Laurin
authors.affiliation: Research Centre, Montreal Heart Institute, affiliated with Université de Montréal, Montreal, Canada; Department of Medicine, Montreal Heart Institute, Montreal, Canada.
authors.forename: Denis
authors.initials: D
authors.lastname: Burelle
authors.affiliation: Research Centre, Montreal Heart Institute, affiliated with Université de Montréal, Montreal, Canada; Montreal Behavioural Medicine Centre, Research Centre, Department of Chest Medicine, Hôpital du Sacré-Cœur de Montréal, affiliated with Université de Montréal, Montreal, Canada; Department of Psychology, Université du Québec à Montréal (UQAM), Montreal, Canada; Department of Psychology, University of Calgary, Alberta, Canada.
authors.forename: Kim
authors.initials: K
authors.lastname: Lavoie
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D002245:Carbon Dioxide / Q000008:administration & dosage; D003324:Coronary Artery Disease / Q000150:complications* / Q000523:psychology; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000523:psychology*; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D010200:Panic; D016584:Panic Disorder / Q000150:complications*; D019275:Radiopharmaceuticals; D012306:Risk; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods
chemical_list: D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D002245:Carbon Dioxide; C078700:technetium tc-99m tetrofosmin
keywords: Coronary artery disease; Exercise stress test; Myocardial ischemia; Myocardial perfusion defects; Panic attacks; Panic disorder