Effect of Mental Stress on Myocardial Perfusion in Women
Condition: Non-Obstructive Coronary Atherosclerosis
MeSH terms: Atherosclerosis; Coronary Artery Disease; Myocardial Ischemia; Stress, Psychological
Study type: Interventional

Summary: 
      Mental stress-induced myocardial ischemia(MSIMI) has been recognized a significant clinical
      problem. Evidence has shown that individuals with MSIMI have 2 to 2.5 times higher risk to
      develop a major averse cardiovascular events over 3-5 years, compared to their counterparts
      who have no MSIMI. Nevertheless, investigations into the study of MSIMI among women who have
      chest pain but artery stenosis < 50% have been lacking. In this project, the investigators
      used positron emission tomography (PET) to evaluate perfusion defect during mental stress to
      diagnose MSIMI. Women with chest pain and coronary artery stenosis < 50% were included as the
      experimental group, age-matched healthy people as the control group, the aim of this study is
      to compare the incidence of MSIMI in the two groups. At the same time, the study also observe
      the change of MBF during mental stress and the relationship between MBF and MSIMI.
    

Detailed description: 
      The goals of this project are to assess MSIMI prevalence in chest pain women with coronary
      artery stenosis less than 50%, as compared to age matched healthy women, and the MBF change
      during mental stress and adenosine vasodilator stress by PET with N-13 ammonia . This study
      will also establish the methodology of echocardiography to diagnose MSIMI by comparing with
      PET. To evaluate the consistency of myocardial blood flow (MBF by PET-CT) and peripheral
      blood flow (PAT ratio by EndoPAT) during stress test. and to explore the pathogenesis of
      MSIMI from aspects of neuroendocrine mechanism, sex hormone level, humoral immunity index and
      proteome expression.

      The stress testing will be conducted at the PET-CT and echocardiography unit of Guangdong
      Provincial People's Hospital. Following a 20-minute calibration-rest period, participants
      will be asked to complete a series of 3 consecutive mental stress tasks. The mental stress
      tests are embedded in the virtual reality device, and the subjects can carry out the mental
      stress test with the virtual reality device on their heads. (1) Stroop Color-Word test, is
      administered by computer on a video monitor. A word appeared in the middle of the screen-Red,
      Green, Yellow, or Blue-in one of these four colors. At the bottom of the screen the words
      Red, Green, Yellow, and Blue appeared with the font color not matching the word meaning. The
      participant is asked to match the color of the word in the middle of the screen with the
      meaning of the color word at the bottom by clicking on the correct option, which lasts about
      4 minutes. and then (2) Public speaking with anger recall: during this test, patients will be
      asked to give a speech on a recent situation in which they experienced anger to an audience
      of three observers (doctors) after 1 minute of preparation. Prior to the speech, subjects are
      told that their speech will be evaluated on their description of the situation, as to what
      happened, what they thought, felt, what they did, and what happened as a result. If they run
      out of things to say, the research tech will prompt them with questions to elicit more
      content until the three minutes are up. and at last the (3) Mental arithmetic: during this
      test, patients will be asked to perform a series of serial subtractions beginning at a given
      number which will be different for each repeated test and will be chosen by the tester from a
      fixed list of various numbers, with encouragement to perform calculations as quickly as
      possible; Each mental stress lasts for 4 minutes, there is no rest between the two mental
      stress, and the whole process of mental stress is 12 minutes.
    

Intervention name(s): Mental Stress Test
Intervention type(s): Diagnostic Test
Intervention description(s): In this study, we compare MSIMI prevalence in the two groups (chest pain group and no chest pain group). Each subject in both groups receive the same mental stress test process, and the mental stress test process have 3 consecutive stress tests, which including: Stroop Color-Word test; Public speaking with anger recall test and Mental arithmetic test.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Diagnostic
Keywords: Stress; Ischemia; PET-CT