Abstract
BackgroundPatients with myocardial ischemia in the absence of obstructive coronary artery disease (CAD) often experience anginal complaints and are at risk of cardiac events. Stress-related psychological factors and acute negative emotions might play a role in these patients with suspect coronary microvascular dysfunction (CMD). Methods and Results295 Patients (66.9 ± 8.7 years, 46% women) undergoing myocardial perfusion single-photon-emission computed tomography (MPI-SPECT), were divided as follows: (1) a non-ischemic reference group (n = 136); (2) patients without inducible ischemia, but with a history of CAD (n = 62); (3) ischemia and documented CAD (n = 52); and (4) ischemia and suspect CMD (n = 45). These four groups were compared with regard to psychological factors and acute emotions. Results revealed no differences between the groups in psychological factors (all P > .646, all effect sizes d < .015). State sadness was higher for patients with suspect CMD (16%) versus the other groups (P = .029). The groups did not differ in the association of psychological factors or emotions with anginal complaints (all P values > .448). ConclusionSuspect CMD was not associated with more negative psychological factors compared to other groups. State sadness was significantly higher for patients with suspect CMD, whereas no differences in state anxiety and other psychological factors were found.
Highlights
The presence of myocardial ischemia in the absence of obstructive coronary artery disease (CAD) is not as benign as previously assumed and is associated with elevated cardiovascular risk[1,2] such as recurrent diagnostic testing, poor quality of life, hospitalization, and long-term adverse cardiac events[3,4,5]
Suspect coronary microvascular dysfunction (CMD) was not associated with more negative psychological factors compared to other groups
There were significant gender differences between the four groups; women were more prevalent in the suspect CMD group (56%) and the reference group (59%), whereas men were significantly more often represented in the ischemic CAD group (79%) and the history of CAD group (69%) than women (P \ .001)
Summary
The presence of myocardial ischemia in the absence of obstructive CAD (non-obstructive CAD; coronary stenosis \ 50%) is not as benign as previously assumed and is associated with elevated cardiovascular risk[1,2] such as recurrent diagnostic testing, poor quality of life, hospitalization, and long-term adverse cardiac events[3,4,5]. We aim to examine psychological factors and acute emotions in patients referred for myocardial perfusion imaging to detect myocardial ischemia. Suspect CMD is operationalized as the presence of myocardial ischemia observed using myocardial perfusion imaging (MPI), while obstructive CAD has been ruled out based on coronary angiography. This operationalization is consistent with the suspect microvascular angina definition of Ong[9]. There is a need to examine the role of psychological factors and acute emotions in the CMD group, given the prevalence of distress associated with recurrent symptoms such as anginal chest pain[6]. Stress-related psychological factors and acute negative emotions might play a role in these patients with suspect coronary microvascular dysfunction (CMD)
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