Objective Ischemia, Subjective Angina, and Psychological Distress in Angina With No Obstructive Coronary Disease
Background Angina with no obstructive coronary disease (ANOCA) and ischemia with no obstructive coronary disease, prevalent yet underrecognized conditions, mostly affect women. Previous studies rarely distinguished between them. We aimed to compare the prevalence of objective ischemia through variou...
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Wiley
2024-08-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.034644 |
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| author | Yuting Liu Wei Jiang Haochen Wang Mingyu Xu Yingxue Liao Haofeng Zhou Bingqing Bai Fengyao Liu Han Yin Quanjun Liu Yanting Liang Xueju Yu Lan Guo Shuxia Wang Huan Ma Qingshan Geng |
| author_facet | Yuting Liu Wei Jiang Haochen Wang Mingyu Xu Yingxue Liao Haofeng Zhou Bingqing Bai Fengyao Liu Han Yin Quanjun Liu Yanting Liang Xueju Yu Lan Guo Shuxia Wang Huan Ma Qingshan Geng |
| author_sort | Yuting Liu |
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| description | Background Angina with no obstructive coronary disease (ANOCA) and ischemia with no obstructive coronary disease, prevalent yet underrecognized conditions, mostly affect women. Previous studies rarely distinguished between them. We aimed to compare the prevalence of objective ischemia through various examinations in women with ANOCA and assess the impact of objective and subjective ischemia on their mental health. Methods and Results A total of 84 eligible women with ANOCA and 42 controls underwent mental stress, pharmacological stress, exercise stress, and Holter testing. Objective evidence of myocardial ischemia was assessed by positron emission tomography‐computed tomography and ECG, and subjective symptoms were graded using the Canadian Cardiovascular Society scale (CCS). Psychological assessments were conducted using 6 scales. Among 84 women with ANOCA, 37 (44%) received a diagnosis of ischemia with no obstructive coronary disease following mental stress testing, 20 (28.6%) through pharmacological stress testing, 14 (21.2%) via exercise stress testing, and 24 (32.9%) from Holter. Mental stress‐induced myocardial ischemia was more prevalent (P<0.05). Among 54 patients with ANOCA who completed all tests, 30% showed no ischemia, and only 1 (1.9%) showed ischemia in all tests. In addition, patients with ANOCA had higher psychological scores than controls (P<0.01). No significant differences was observed in psychological scores between ANOCA with positive and negative ischemia test results (P>0.05). However, ANOCA with milder angina (CCS I) exhibited higher scores across the Hospital Anxiety and Depression Scale, State‐Trait Anxiety Inventory, Perceived Stress Scale, and Posttraumatic Stress Disorder Checklist‐Civilian Version and a higher prevalence of Type D personality traits (P<0.05). Conclusions In patients with ANOCA, the positive rate of myocardial ischemia exhibits variability among several noninvasive tests. A worsened psychological state is more closely linked to milder angina symptoms than to ischemia performance, highlighting the importance of focusing on symptom management in their psychological care. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03982901. |
| format | Article |
| id | doaj-art-f98e7cfbc38c4cbf813cfcc3fa88ba30 |
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| publishDate | 2024-08-01 |
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| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-f98e7cfbc38c4cbf813cfcc3fa88ba302025-08-20T02:12:49ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802024-08-01131510.1161/JAHA.124.034644Objective Ischemia, Subjective Angina, and Psychological Distress in Angina With No Obstructive Coronary DiseaseYuting Liu0Wei Jiang1Haochen Wang2Mingyu Xu3Yingxue Liao4Haofeng Zhou5Bingqing Bai6Fengyao Liu7Han Yin8Quanjun Liu9Yanting Liang10Xueju Yu11Lan Guo12Shuxia Wang13Huan Ma14Qingshan Geng15Guangdong Provincial Clinical Research Center for Geriatrics, Shenzhen Clinical Research Center for Geriatrics Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology) Shenzhen Guangdong ChinaDepartment of Internal Medicine, Department of Psychiatry and Behavioral Sciences Duke University Medical Center Durham NC USADepartment of Cardiology Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University Guangzhou Guangzhou ChinaDepartment of Cardiology Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University Guangzhou Guangzhou ChinaDepartment of Cardiology Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University Guangzhou Guangzhou ChinaDepartment of Cardiology Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University Guangzhou Guangzhou ChinaDepartment of Cardiology Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University Guangzhou Guangzhou ChinaDepartment of Cardiology Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University Guangzhou Guangzhou ChinaGuangdong Provincial Clinical Research Center for Geriatrics, Shenzhen Clinical Research Center for Geriatrics Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology) Shenzhen Guangdong ChinaDepartment of Cardiology Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University Guangzhou Guangzhou ChinaGuangdong Provincial Clinical Research Center for Geriatrics, Shenzhen Clinical Research Center for Geriatrics Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology) Shenzhen Guangdong ChinaDepartment of Cardiology Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University Guangzhou Guangzhou ChinaDepartment of Cardiology Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University Guangzhou Guangzhou ChinaDepartment of Nuclear Medicine, Guangdong Provincial People’s Hospital Guangdong Academy of Medical Sciences, Southern Medical University Guangzhou ChinaDepartment of Cardiology Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University Guangzhou Guangzhou ChinaGuangdong Provincial Clinical Research Center for Geriatrics, Shenzhen Clinical Research Center for Geriatrics Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology) Shenzhen Guangdong ChinaBackground Angina with no obstructive coronary disease (ANOCA) and ischemia with no obstructive coronary disease, prevalent yet underrecognized conditions, mostly affect women. Previous studies rarely distinguished between them. We aimed to compare the prevalence of objective ischemia through various examinations in women with ANOCA and assess the impact of objective and subjective ischemia on their mental health. Methods and Results A total of 84 eligible women with ANOCA and 42 controls underwent mental stress, pharmacological stress, exercise stress, and Holter testing. Objective evidence of myocardial ischemia was assessed by positron emission tomography‐computed tomography and ECG, and subjective symptoms were graded using the Canadian Cardiovascular Society scale (CCS). Psychological assessments were conducted using 6 scales. Among 84 women with ANOCA, 37 (44%) received a diagnosis of ischemia with no obstructive coronary disease following mental stress testing, 20 (28.6%) through pharmacological stress testing, 14 (21.2%) via exercise stress testing, and 24 (32.9%) from Holter. Mental stress‐induced myocardial ischemia was more prevalent (P<0.05). Among 54 patients with ANOCA who completed all tests, 30% showed no ischemia, and only 1 (1.9%) showed ischemia in all tests. In addition, patients with ANOCA had higher psychological scores than controls (P<0.01). No significant differences was observed in psychological scores between ANOCA with positive and negative ischemia test results (P>0.05). However, ANOCA with milder angina (CCS I) exhibited higher scores across the Hospital Anxiety and Depression Scale, State‐Trait Anxiety Inventory, Perceived Stress Scale, and Posttraumatic Stress Disorder Checklist‐Civilian Version and a higher prevalence of Type D personality traits (P<0.05). Conclusions In patients with ANOCA, the positive rate of myocardial ischemia exhibits variability among several noninvasive tests. A worsened psychological state is more closely linked to milder angina symptoms than to ischemia performance, highlighting the importance of focusing on symptom management in their psychological care. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03982901.https://www.ahajournals.org/doi/10.1161/JAHA.124.034644angina with no obstructive coronary diseaseanxietydepressionischemia with no obstructive coronary diseasemental stress‐induced myocardial ischemia |
| spellingShingle | Yuting Liu Wei Jiang Haochen Wang Mingyu Xu Yingxue Liao Haofeng Zhou Bingqing Bai Fengyao Liu Han Yin Quanjun Liu Yanting Liang Xueju Yu Lan Guo Shuxia Wang Huan Ma Qingshan Geng Objective Ischemia, Subjective Angina, and Psychological Distress in Angina With No Obstructive Coronary Disease Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease angina with no obstructive coronary disease anxiety depression ischemia with no obstructive coronary disease mental stress‐induced myocardial ischemia |
| title | Objective Ischemia, Subjective Angina, and Psychological Distress in Angina With No Obstructive Coronary Disease |
| title_full | Objective Ischemia, Subjective Angina, and Psychological Distress in Angina With No Obstructive Coronary Disease |
| title_fullStr | Objective Ischemia, Subjective Angina, and Psychological Distress in Angina With No Obstructive Coronary Disease |
| title_full_unstemmed | Objective Ischemia, Subjective Angina, and Psychological Distress in Angina With No Obstructive Coronary Disease |
| title_short | Objective Ischemia, Subjective Angina, and Psychological Distress in Angina With No Obstructive Coronary Disease |
| title_sort | objective ischemia subjective angina and psychological distress in angina with no obstructive coronary disease |
| topic | angina with no obstructive coronary disease anxiety depression ischemia with no obstructive coronary disease mental stress‐induced myocardial ischemia |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.034644 |
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