Assessing myocardial microcirculation in post-PCI patients with chest pain and anxiety: a dynamic CT myocardial perfusion study with mental stress testing

Fig. 1. Schematic illustration of the study design. A total of 58 patients were recruited. 7 patients were excluded as follows: 2 patients did not complete the anxiety assessment; 2 patients refused the stress CT-MPI; 2 patients could not complete the mental stress tests; and the image quality of one patient was insufficient for analysis. Finally, this study included 51 patients. All participants underwent anxiety assessment before MS-CTMPI. After anxiety assessment, the rest-phase MS-CTMPI was performed. Subsequently, the participants rested for 5 minutes before the MST. Then the stress-phase MS-CTMPI was performed

Fig. 2. Representative imaging findings of a post-PCI patient without anxiety. (A-C) Coronary computed tomography angiography (CCTA) shows a stent in the proximal part of the LAD. The blood flow in the stent is smooth. No obstructive stenosis is seen in LAD, LCX, and RCA. (D, F) Rest-phase CT-MPI showing no hypo-perfused area; (E, G) After MST, MBF is increased in the stress-phase CT-MPI

Fig. 3. Representative imaging findings of a post-PCI patient with anxiety. (A-C) Coronary computed tomography angiography (CCTA) shows a stent in the proximal part of LM and LAD. The blood flow in the stent is smooth. No obstructive stenosis is found in LAD, LCX, and RCA. (D, F) MBF in the rest-phase CT-MPI shows hypo-perfusion changes in some segments; (E, G) After MST, the MBF in the stress-phase CT-MPI has further decreased

Fig. 4. Violin plots showing the distribution and values of global MBF and MBF in each coronary area before and after MST. A) In the non-anxiety group, the global MBF value and MBF value of each coronary area increased after MST. B) In the anxiety group, no significant changes were observed in the global MBF value and MBF value of each coronary area before and after MST. MST, mental stress test; MBF, myocardial blood flow

Fig. 5. A) Violin plots showing the distribution and values of MBF in the stent and non-stent areas, before and after MST. The MBF value of the stent area was significantly lower than that of the non-stent area. B) Violin plots showing the distribution and value of MBF in anxiety and non-anxiety patients in the rest and stress phases, before and after MST. The MBF value of the stent area of anxiety patients decreased after MST. The MBF value of the stent area of non-anxiety patients increased after MST

Fig. 6. Violin plots showing the distribution and values of MFR. A) The MFR of non-anxiety patients was significantly higher than that of anxiety patients. B) The MFR of non-stent areas in anxiety patients was significantly higher than that of the stent area. C) There was no significant difference in the MFR of non-anxiety patients between the stent and non-stent areas

Fig. 7. Lollipop plot showing the correlation between the MBF, MFR, and the degree of anxiety

Fig. 8. Forest plot showing risk factors for chest pain after PCI