The Foundational Role of Cardiovascular Imaging in the Characterization of Mental Stress –Induced Myocardial Ischemia in Patients with Coronary Artery Disease

AbstractPurpose of ReviewMental stress –provoked myocardial ischemia (MSIMI) is an ischemic phenomenon provoked by the experience of psychologically stressful circumstances. While MSIMI was initially identified 50 years ago during activities of daily living through the use of wearable Holter monitor, subsequent research utilized the t echnologies of cardiac imaging—ventriculography and myocardial perfusion—under controlled conditions to pursue an understanding of pathophysiology and prognosis. This work revealed that MSIMI occurs in almost half of patients with stable coronary artery disease (CAD) and is associated with cardi ac events and early mortality. We provide a focused review of the instrumental role that cardiac imaging has played in elucidating how stress affects cardiac physiology and how emerging diagnostic techniques will allow for further research on stress-mediated changes in the coronary macro- and microv asculature.Recent FindingsObservations about the cardiac response to mental stress diverge from underlying cornerstones of the traditional CAD paradigm which is based upon myocardial oxygen demand and the degree of epicardial coronary stenosis. Evidence from studies utilizing non-invasive and invasive studies of coronary perfusion indicates perturbations in the microvascular compartment in response to mental stress.SummaryCardiovascular imaging enjoined with mental stress provocation may be a commanding tool to advance our understanding of non-obstruct...
Source: Current Cardiology Reports - Category: Cardiology Source Type: research