Assessing Myocardial Microcirculation in Patients with Anxiety and Non‑obstructive Coronary Artery Disease: A Comparative Study of Pharmacologic versus Mental Stress CT Myocardial Perfusion Imaging

RATIONALE AND OBJECTIVES: Some patients with angina and non‑obstructive coronary artery disease (ANOCA) frequently present with anxiety. Mental stress can induce myocardial ischemia in patients with anxiety. This study aimed to assess myocardial microcirculation using dynamic CT myocardial perfusion imaging (CT-MPI) with mental stress test (MST) and pharmacologic stress test (PST) in ANOCA patients with anxiety. MATERIALS AND METHODS: ANOCA patients underwent CT-MPI with MST using a series of the standardized color word/arithmetic stressors and PST using regadenoson, and divided into anxiety group and non-anxiety group according to the generalized anxiety disorder scale. Myocardial blood flow (MBF) and myocardial blood flow reserve (MFR) were analyzed, using a 17-segment model. RESULTS: Sixty patients with 1020 segments were included for final analysis, including 29 patients with anxiety and 31 patients without anxiety. After MST, MBF value of the anxiety group was lower than that at rest (P < 0.05), and the anxiety group had a lower MFR compared to the non-anxiety group (P < 0.05); Anxiety severity was negatively correlated with global MFR and ΔGlobal-MBF value (r = -0.633, P < 0.001, r = -0.667, P < 0.001) and positively correlated with decreased global MBF value (r = 0.561, P = 0.01). In contrast, no significant differences or correlations were observed between the two groups after PST (P > 0.05). Multivariate logistic regression analysis revealed that anxiety is an independent risk factor for MBF reduction after MST in patients with ANOCA (OR=3.294, 95% CI: 1.009-10.754, P=0.046). CONCLUSIONS: Anxiety is associated with myocardial microcirculation dysfunction (MMD) in patients with ANOCA. Anxiety is a risk factor for MMD under mental stress in ANOCA patients.