%0 Journal Article %A Andrew J Wawrzyniak %A Vasken Dilsizian %A David S Krantz %A Kristie M Harris %A Mark Smith %A Anthony Shankovich %A Kerry S Whittaker %A Gabriel A Rodrigues %A John Gottdiener %A Shuying Li %A Wilhelm Kop %A Stephen Gottlieb %T High Concordance Between Mental Stress-Induced and Adenosine-Induced Myocardial Ischemia Assessed Using SPECT in Heart Failure Patients: Hemodynamic and Biomarker Correlates %D 2015 %R 10.2967/jnumed.115.157990 %J Journal of Nuclear Medicine %P jnumed.115.157990 %X Background: Mental stress can trigger myocardial ischemia, but the prevalence of mental stress-induced ischemia in CHF patients is unknown.. We characterized mental stress-induced and adenosine-induced changes in myocardial perfusion and neurohormonal activation in CHF patients with reduced LV function using single-photon emission computed tomography (SPECT) to precisely quantify segment-level myocardial perfusion. Materials and Methods: 34 coronary artery disease (CAD) patients (age 62±10 years) with CHF>3 months, ejection fraction<40% underwent both adenosine and mental stress myocardial perfusion SPECT on consecutive days. Mental stress consisted of anger recall (anger-provoking speech) followed by subtracting serial 7s). Presence and extent of myocardial ischemia was quantified using the conventional 17 segment model. Results: 68% of patients had ≥1 ischemic segment during mental stress; 81% during adenosine. On segment-by-segment analysis, perfusion to mental stress and adenosine were highly correlated. No significant differences were found between any two time points for BNP, TNF-alpha, IL-1b, troponin, VEGF, IL-17a, MMP-9, or CRP. However, ET-1 and IL-6 increased, and IL-10 decreased, between the stressor and 30 minutes post-stress.Left ventricular end diastolic dimension was 179±65 ml at rest and increased to 217±71 after mental stress and 229±86 after adenosine (p<0.01 for both). Resting end systolic volume was 129±60 ml at rest and increased to 158±66 after mental stress (p<0.05) and 171±87 after adenosine (p0.07), with no significant differences between adenosine and mental stress. Ejection fraction was 30±12 at baseline, 29±11 with mental stress, and 28±10 with adenosine (P = NS). Conclusion: There was high concordance between ischemic perfusion defects induced by adenosine and mental stress, suggesting that mental stress is equivalent to pharmacologic stress in eliciting clinically significant \myocardial perfusion defects in CHF patients. Cardiac dilatation suggests clinically important changes with both conditions. Psychosocial stressors during daily life may contribute to the ischemic burden of CHF patients with CAD. %U https://jnm.snmjournals.org/content/jnumed/early/2015/07/22/jnumed.115.157990.full.pdf