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Quantitation of diffuse myocardial ischemia with mental stress and its association with cardiovascular events in individuals with recent myocardial infarction

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Journal of Nuclear Cardiology Aims and scope

Abstract

Microcirculatory dysfunction during psychological stress may lead to diffuse myocardial ischemia. We developed a novel quantification method for diffuse ischemia during mental stress (dMSI) and examined its relationship with outcomes after a myocardial infarction (MI). We studied 300 patients ≤ 61 years of age (50% women) with a recent MI. Patients underwent myocardial perfusion imaging with mental stress and were followed for 5 years. dMSI was quantified from cumulative count distributions of rest and stress perfusion. Focal ischemia was defined in a conventional fashion. The main outcome was a composite outcome of recurrent MI, heart failure hospitalizations, and cardiovascular death. A dMSI increment of 1 standard deviation was associated with a 40% higher risk for adverse events (HR 1.4, 95% CI 1.2–1.5). Results were similar after adjustment for viability, demographic and clinical factors and focal ischemia. In sex-specific analysis, higher levels of dMSI (per standard deviation increment) were associated with 53% higher risk of adverse events in women (HR 1.5, 95% CI 1.2–2.0) but not in men (HR 0.9, 95% CI 0.5–1.4), P 0.001. A novel index of diffuse ischemia with mental stress was associated with recurrent events in women but not in men after MI.

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Abbreviations

dMSI:

Diffuse Mental Stress Induced Myocardial Ischemia

fMSI:

Focal Mental Stress Induced Myocardial Ischemia

MI:

Myocardial Infarction

MSI:

Mental Stress Induced Myocardial Ischemia

SPECT:

Single-photon emission computed tomography

HR:

Hazard ratio

CI:

Confidence Interval

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Acknowledgments

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Funding

This work was supported by the NIH, through the following grants: R01 HL109413, R01HL109413-02S1, P01 HL101398, K24HL077506, K24 MH076955, KL2TR000455, K23HL127251, TL1TR002382, F32HL151163, T32HL130025, L30HL148912, K12HD085850, UL1TR002378 and K01HL149982.

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Authors and Affiliations

  1. Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA

    Zakaria Almuwaqqat MD, Amit J. Shah MD, Samaah Sullivan PhD & Viola Vaccarino MD, PhD

  2. Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, USA

    Zakaria Almuwaqqat MD, Mariana Garcia MD, Amit J. Shah MD, Arshed A. Quyyumi MD & Viola Vaccarino MD, PhD

  3. Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA

    Ernest V. Garcia PhD, C. David Cooke MSEE, Jonathon Nye PhD, Marly Van Assen MD, Carlo De Cecco MD, PhD & J. Douglas Bremner MD

  4. Atlanta VA Medical Center, Decatur, GA, USA

    Amit J. Shah MD & J. Douglas Bremner MD

  5. Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA

    Lisa Elon MS, MPH & Yi-An Ko PhD

  6. Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA

    J. Douglas Bremner MD

  7. Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada

    Paolo Raggi MD

  8. Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Sciences Center, Houston, TX, USA

    Samaah Sullivan PhD

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  1. Zakaria Almuwaqqat MD
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  2. Ernest V. Garcia PhD
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  4. Mariana Garcia MD
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Correspondence to Zakaria Almuwaqqat MD.

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Disclosures

Dr. De Cecco receives research funding from Siemens Healthineers and he is a consultant for Covanos. Dr. Ernest V. Garcia receives royalties from the sale of the Emory Cardiac Toolbox, used for some analyses in this study. None of the other authors report conflict of interest relevant to this article.

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Almuwaqqat, Z., Garcia, E.V., Cooke, C.D. et al. Quantitation of diffuse myocardial ischemia with mental stress and its association with cardiovascular events in individuals with recent myocardial infarction. J. Nucl. Cardiol. 30, 2029–2038 (2023). https://doi.org/10.1007/s12350-023-03212-8

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