Association of pre-procedural state and trait anxiety with myocardial perfusion SPECT findings: A prospective observational study in patients undergoing 99mTc-Sestamibi imaging

Background Anxiety is common among patients undergoing myocardial perfusion SPECT (MPS). This study aimed to investigate whether pre-procedural state anxiety influences MPS outcomes and to compare the predictive value of state versus trait anxiety. Methods This prospective observational study included 152 patients referred for 99mTc-sestamibi MPS. Pre-procedural anxiety was assessed using the State-Trait Anxiety Inventory (STAI). Patients were categorized into low, moderate, and high state anxiety groups. The primary outcome was a positive MPS result (presence of reversible or fixed perfusion defects). Univariate and multivariate logistic regression analyses were performed to identify independent predictors of positive MPS. Results No significant difference was observed in the rate of positive MPS across low (22.9%), moderate (23.7%), and high (21.8%) state anxiety groups (p=0.973). In contrast, trait anxiety was significantly associated with positive MPS. In multivariate analysis, moderate trait anxiety (OR 12.41, 95 % CI 2.25–68.24, p=0.004) and high trait anxiety (OR 27.30, 95 % CI 4.42–168.54, p<0.001) remained independent predictors of a positive MPS result, together with male sex. The overall test for state anxiety was not statistically significant (p=0.061). The high-versus-low contrast showed an inverse association (OR 0.16, 95 % CI 0.02–0.96, p=0.045). Conclusion Trait anxiety, but not pre-procedural state anxiety, was independently associated with a positive myocardial perfusion SPECT result. The underlying anatomical and pathophysiological mechanisms remain undetermined.