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Dynamic myocardial perfusion computed tomography with mental stress test to detect changes in myocardial microcirculation in patients with anxiety and no obstructive coronary artery disease

  • Vascular-Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

Mental stress can induce myocardial ischemia in patients with anxiety and other psychological disorders. Computed tomography myocardial perfusion imaging (CT-MPI) has the potential to quantitatively diagnose myocardial ischemia. The aim of this study was to measure changes in myocardial microcirculation perfusion (MMP) in patients with anxiety who have angina symptoms/ischemia but no obstructive coronary artery disease (INOCA) using dynamic CT-MPI in combination with a mental stress test.

Methods

Patients with INOCA were divided into five subgroups (none, minimal, mild, moderate, and severe) according to the generalized anxiety disorder scale. Patients underwent dynamic CT-MPI with mental stress testing using a series of the standardized color word/arithmetic stressors. Myocardial blood flow (MBF) during resting and stress phases of CT-MPI was recorded.

Results

Fifty-eight patients with 986 segments were included for final analysis. Compared to patients with none, minimal, mild, and moderate anxiety, those with severe anxiety had the largest rate of MBF decrease and the largest MBF decrease value. At the same time, those with no anxiety had the largest rate of MBF increase, the largest MBF increase value (all p < 0.05). As anxiety intensified, the rate of MBF increased and the MBF value increased (r = −0.24, r = −0.27, p < 0.05). Concomitantly, the rate of MBF decreased and the MBF value decreased (r = 0.63, r = 0.43, p < 0.05).

Conclusions

Dynamic CT-MPI with a mental stress test can be used to evaluate MMP in patients with anxiety and INOCA. Mental stress resulted in significant differences in changes in the rate and value of MBF among patients with different anxiety degrees.

Key Points

• Dynamic CT-MPI with mental stress test worked well to quantitatively evaluate myocardial microcirculation perfusion in patients with anxiety and INOCA.

• The rates of MBF decrease and MBF decrease value were positively correlated with anxiety degree of anxiety patients with INOCA.

• MBF change derived from CT-MPI with mental stress test had a good performance to predicting anxiety degree of patients with anxiety and INOCA.

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Abbreviations

CAD:

Coronary artery disease

CCTA:

Coronary CT angiography

CMD:

Coronary microvascular dysfunction

CT-MPI:

Computed tomography myocardial perfusion imaging

INOCA:

No obstructive coronary artery disease

MBF:

Myocardial blood flow

MMP:

Myocardial microcirculation perfusion

MMP:

Myocardial microvascular dysfunction

MSIMI:

Mental stress-induced myocardial ischemia

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Funding

The authors state that this work has not received any funding.

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Author notes

  1. Zhongyan Li and Xiaofeng Qu contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, The Second Hospital of Dalian Medical University, No.467 Zhongshan Road, Shahekou District, Dalian City, Liaoning Province, China

    Weihang Sun, Lingjun Mei & Xiaofeng Qu

  2. Department of Radiology, The Second Hospital of Dalian Medical University (Diamond Bay), Dalian City, Liaoning Province, China

    Aodan Zhang

  3. Department of Cardiology, The Second Hospital of Dalian Medical University, No.467 Zhongshan Road, Shahekou District, Dalian City, Liaoning Province, China

    Xiangting Liu & Zhongyan Li

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  1. Weihang Sun
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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

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Written informed consent was obtained from all subjects (patients) in this study.

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Sun, W., Zhang, A., Mei, L. et al. Dynamic myocardial perfusion computed tomography with mental stress test to detect changes in myocardial microcirculation in patients with anxiety and no obstructive coronary artery disease. Eur Radiol 33, 6522–6533 (2023). https://doi.org/10.1007/s00330-023-09607-y

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  • DOI: https://doi.org/10.1007/s00330-023-09607-y

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