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Fukumoto Y, Tsuji Y, Kakuda A, Hori R, Kudo S. Non-invasive evaluation of autonomic responses in patients with rotator cuff tear-related nocturnal pain. J Phys Ther Sci 2024; 36:111-116. [PMID: 38434993 PMCID: PMC10904215 DOI: 10.1589/jpts.36.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/25/2023] [Indexed: 03/05/2024] Open
Abstract
[Purpose] We aimed to determine the autonomic response in patients with rotator cuff tear-related nocturnal pain using nonlinear analysis of heart rate variability. [Participants and Methods] Twenty-eight patients with nocturnal pain who were diagnosed with a rotator cuff tear and received steroid injections, and whose nocturnal pain improved, were divided into a control group (14 patients) and a failure group (14 patients). Pulse wave was measured continuously using BACS Advance equipment (TAOS Co.) for a total of 17 min: 5 min before isometric hand grip, 2 min during isometric hand grip, 5 min after isometric hand grip, and 10 min after isometric hand grip. The autonomic nervous system activity was assessed using detrended fluctuation analysis and approximate entropy. [Results] The α1 values obtained from the detrended fluctuation analysis were significantly higher in the failure group than in the control group at each measurement period. The approximate entropy was normal in 12 (85%) patients in the control group and six (42%) patients in the failure group; it was abnormal in two (15%) patients in the control group and eight (58%) patients in the failure group. [Conclusion] Among patients experiencing nocturnal pain, several have abnormal autonomic response during isometric hand grip.
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Affiliation(s)
- Yusuke Fukumoto
- Graduate School of Health Sciences, Morinomiya University
of Medical Sciences: 1-26-16 Nankoukita Suminoe-ku, Osaka-shi, Osaka 559-8611, Japan
- Keimoto Orthopedic Rehabilitation and Osteoporosis Clinic,
Japan
| | - Yoshihiro Tsuji
- Graduate School of Health Sciences, Morinomiya University
of Medical Sciences: 1-26-16 Nankoukita Suminoe-ku, Osaka-shi, Osaka 559-8611, Japan
- Department of Clinical Engineering, Morinomiya University
of Medical Sciences, Japan
- Inclusive Medical Science Research Institute, Morinomiya
University of Medical Sciences, Japan
| | - Akihiro Kakuda
- Graduate School of Health Sciences, Morinomiya University
of Medical Sciences: 1-26-16 Nankoukita Suminoe-ku, Osaka-shi, Osaka 559-8611, Japan
- Inclusive Medical Science Research Institute, Morinomiya
University of Medical Sciences, Japan
| | - Ryuji Hori
- Graduate School of Health Sciences, Morinomiya University
of Medical Sciences: 1-26-16 Nankoukita Suminoe-ku, Osaka-shi, Osaka 559-8611, Japan
- Inclusive Medical Science Research Institute, Morinomiya
University of Medical Sciences, Japan
| | - Shintarou Kudo
- Graduate School of Health Sciences, Morinomiya University
of Medical Sciences: 1-26-16 Nankoukita Suminoe-ku, Osaka-shi, Osaka 559-8611, Japan
- Inclusive Medical Science Research Institute, Morinomiya
University of Medical Sciences, Japan
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Fukumoto Y, Tsuji Y, Kakuda A, Hori R, Kitano M, Sakamoto K, Kudo S. Evaluation of autonomic nervous system responses during isometric handgrip exercise using nonlinear analysis of heart rate variability. J Phys Ther Sci 2022; 34:689-693. [PMID: 36213191 PMCID: PMC9535244 DOI: 10.1589/jpts.34.689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 07/21/2022] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to examine, using a plethysmogram of the
fingertips, autonomic responses at motor intensities of 30% or 50% of maximum voluntary
contraction (MVC) during isometric handgrip exercise (IHG). [Participants and Methods] The
participants of this study were 15 healthy persons. The finger volume pulse wave of each
participant was measured continuously, using a BACS Advance equipment (TAOS Co.), for a
total of 17 minutes: 5 minutes before IHG (Pre), 2 minutes during IHG (IHG), the first 5
minutes after IHG (Post 5), and then the second 5 minutes after IHG (Post 10). To evaluate
autonomic nervous system activity, we used the Detrended fluctuation analysis (DFA) and
Approximate Entropy (ApEn). [Results] During IHG, the pulse rate was significantly higher
and the ApEn value was significantly lower than during the other periods of measurement.
Compared to other analyzed parameters, ApEn decreased during IHG, but returned to its
initial Pre period level during the Post 5 period. The α1 value derived from
the DFA analysis remained at a value of 1 during each measurement time point, indicating
the absence of malfunctions in autonomic response. [Conclusion] Isometric handgrip
exercise with 30% MVC seemed to be useful for the assessment of autonomic nervous system
response.
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Affiliation(s)
- Yusuke Fukumoto
- Graduate School of Health Sciences, Morinomiya University of Medical Sciences: 1-26-16 Nankoukita, Suminoe-ku, Osaka-shi, Osaka 559-8611, Japan
| | - Yoshihiro Tsuji
- Graduate School of Health Sciences, Morinomiya University of Medical Sciences: 1-26-16 Nankoukita, Suminoe-ku, Osaka-shi, Osaka 559-8611, Japan
| | - Akihiro Kakuda
- Graduate School of Health Sciences, Morinomiya University of Medical Sciences: 1-26-16 Nankoukita, Suminoe-ku, Osaka-shi, Osaka 559-8611, Japan
| | - Ryuji Hori
- Graduate School of Health Sciences, Morinomiya University of Medical Sciences: 1-26-16 Nankoukita, Suminoe-ku, Osaka-shi, Osaka 559-8611, Japan
| | - Masashi Kitano
- Graduate School of Health Sciences, Morinomiya University of Medical Sciences: 1-26-16 Nankoukita, Suminoe-ku, Osaka-shi, Osaka 559-8611, Japan
| | - Koudai Sakamoto
- Inclusive Medical Sciences, Morinomiya University of Medical Sciences, Japan
| | - Shintarou Kudo
- Graduate School of Health Sciences, Morinomiya University of Medical Sciences: 1-26-16 Nankoukita, Suminoe-ku, Osaka-shi, Osaka 559-8611, Japan
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Research progress regarding the diagnosis and treatment of mental stress-induced myocardial ischemia. Anatol J Cardiol 2020; 24:126-136. [PMID: 32870175 PMCID: PMC7585978 DOI: 10.14744/anatoljcardiol.2020.69447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Myocardial ischemia resulting from psychological stress [mental stress-induced myocardial ischemia (MSIMI)] refers to the condition wherein psychosocial and psychological stimulations cause myocardial ischemia in patients with coronary heart disease, which is different from drug-induced myocardial ischemia. Therefore, this condition often escapes diagnosis, portends clinical risk, and affects the quality of life of MSIMI survivors. MSIMI is closely related to the poor prognosis of cardiovascular diseases, especially in young women, according to recent randomized, controlled trials (RCTs) on MSIMI. These RCTs involved different sample sizes, interventional measures, and detection techniques. Moreover, differences exist regarding the prevalence rate, distribution characteristics, possible pathogenesis, and clinical significance. Nevertheless, currently, the diagnostic criteria, pathogenesis, and treatment of MSIMI are still in the clinical exploration stage. Hence, considering recent RCTs, this paper summarizes the research status of MSIMI from the aspects of pathogenesis, diagnosis, and treatment strategies to provide a theoretical basis for the follow-up diagnostic methods and treatment guidelines for MSIMI.
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Shah P, Khaleel M, Thuptimdang W, Sunwoo J, Veluswamy S, Chalacheva P, Kato RM, Detterich J, Wood JC, Zeltzer L, Sposto R, Khoo MCK, Coates TD. Mental stress causes vasoconstriction in subjects with sickle cell disease and in normal controls. Haematologica 2019; 105:83-90. [PMID: 30975906 PMCID: PMC6939522 DOI: 10.3324/haematol.2018.211391] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 04/05/2019] [Indexed: 01/02/2023] Open
Abstract
Vaso-occlusive crisis (VOC) is a hallmark of sickle cell disease (SCD) and occurs when deoxygenated sickled red blood cells occlude the microvasculature. Any stimulus, such as mental stress, which decreases microvascular blood flow will increase the likelihood of red cell entrapment resulting in local vaso-occlusion and progression to VOC. Neurally mediated vasoconstriction might be the physiological link between crisis triggers and vaso-occlusion. In this study, we determined the effect of mental stress on microvascular blood flow and autonomic nervous system reactivity. Sickle cell patients and controls performed mentally stressful tasks, including a memory task, conflict test and pain anticipation test. Blood flow was measured using photoplethysmography, autonomic reactivity was derived from electrocardiography and perceived stress was measured by the State-Trait Anxiety Inventory questionnaire. Stress tasks induced a significant decrease in microvascular blood flow, parasympathetic withdrawal and sympathetic activation in all subjects. Of the various tests, pain anticipation caused the highest degree of vasoconstriction. The magnitude of vasoconstriction, sympathetic activation and perceived stress was greater during the Stroop conflict test than during the N-back memory test, indicating the relationship between magnitude of experimental stress and degree of regional vasoconstriction. Baseline anxiety had a significant effect on the vasoconstrictive response in sickle cell subjects but not in controls. In conclusion, mental stress caused vasoconstriction and autonomic nervous system reactivity in all subjects. Although the pattern of responses was not significantly different between the two groups, the consequences of vasoconstriction can be quite significant in SCD because of the resultant entrapment of sickle cells in the microvasculature. This suggests that mental stress can precipitate a VOC in SCD by causing neural-mediated vasoconstriction.
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Affiliation(s)
- Payal Shah
- Division of Hematology, Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles
| | - Maha Khaleel
- Division of Hematology, Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles
| | - Wanwara Thuptimdang
- Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles
| | - John Sunwoo
- Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles
| | - Saranya Veluswamy
- Division of Hematology, Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles
| | - Patjanaporn Chalacheva
- Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles
| | - Roberta M Kato
- Division of Pulmonology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles
| | - Jon Detterich
- Division of Cardiology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles
| | - John C Wood
- Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles.,Division of Cardiology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles
| | - Lonnie Zeltzer
- Pediatric Pain Program, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - Richard Sposto
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michael C K Khoo
- Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles
| | - Thomas D Coates
- Division of Hematology, Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles
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Abstract
This article provides information on psychological assessments based on the most influential stress theories. In understanding the stress response and its relation to disease, clinical vignettes are provided. Emphasis is placed on assessment measures for use in the general population and on providing an overview of evidence for more commonly used instruments in health care. Several advantages and disadvantages afforded by measurement approaches are also addressed (although a full examination of the extent of limitations and issues regarding assessment is beyond the scope of this article). Finally, future considerations regarding proposed research and necessary advances in measurement are discussed.
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Affiliation(s)
- Frances Figueroa-Fankhanel
- Primary Care Mental Health Integration Program, Caribbean Healthcare System, 10 Casia Street, San Juan, PR 00921, USA.
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Wei J, Pimple P, Shah AJ, Rooks C, Bremner JD, Nye JA, Ibeanu I, Murrah N, Shallenberger L, Raggi P, Vaccarino V. Depressive symptoms are associated with mental stress-induced myocardial ischemia after acute myocardial infarction. PLoS One 2014; 9:e102986. [PMID: 25061993 PMCID: PMC4111307 DOI: 10.1371/journal.pone.0102986] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 06/24/2014] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES Depression is an adverse prognostic factor after an acute myocardial infarction (MI), and an increased propensity toward emotionally-driven myocardial ischemia may play a role. We aimed to examine the association between depressive symptoms and mental stress-induced myocardial ischemia in young survivors of an MI. METHODS We studied 98 patients (49 women and 49 men) age 38-60 years who were hospitalized for acute MI in the previous 6 months. Patients underwent myocardial perfusion imaging at rest, after mental stress (speech task), and after exercise or pharmacological stress. A summed difference score (SDS), obtained with observer-independent software, was used to quantify myocardial ischemia under both stress conditions. The Beck Depression Inventory-II (BDI-II) was used to measure depressive symptoms, which were analyzed as overall score, and as separate somatic and cognitive depressive symptom scores. RESULTS There was a significant positive association between depressive symptoms and SDS with mental stress, denoting more ischemia. After adjustment for demographic and lifestyle factors, disease severity and medications, each incremental depressive symptom was associated with 0.14 points higher SDS. When somatic and cognitive depressive symptoms were examined separately, both somatic [β = 0.17, 95% CI: (0.04, 0.30), p = 0.01] and cognitive symptoms [β = 0.31, 95% CI: (0.07, 0.56), p = 0.01] were significantly associated with mental stress-induced ischemia. Depressive symptoms were not associated with ischemia induced by exercise or pharmacological stress. CONCLUSION Among young post-MI patients, higher levels of both cognitive and somatic depressive symptoms are associated with a higher propensity to develop myocardial ischemia with mental stress, but not with physical (exercise or pharmacological) stress.
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Affiliation(s)
- Jingkai Wei
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Pratik Pimple
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Amit J. Shah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Cherie Rooks
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - J. Douglas Bremner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Jonathon A. Nye
- Department of Radiology, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Ijeoma Ibeanu
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Nancy Murrah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Lucy Shallenberger
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Paolo Raggi
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- Mazankowski Alberta Heart Institute, University of Alberta School of Medicine, Edmonton, Alberta, Canada
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, United States of America
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Wei J, Rooks C, Ramadan R, Shah AJ, Bremner JD, Quyyumi AA, Kutner M, Vaccarino V. Meta-analysis of mental stress-induced myocardial ischemia and subsequent cardiac events in patients with coronary artery disease. Am J Cardiol 2014; 114:187-92. [PMID: 24856319 PMCID: PMC4126399 DOI: 10.1016/j.amjcard.2014.04.022] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 04/23/2014] [Accepted: 04/23/2014] [Indexed: 02/02/2023]
Abstract
Mental stress-induced myocardial ischemia (MSIMI) has been associated with adverse prognosis in patients with coronary artery disease (CAD), but whether this is a uniform finding across different studies has not been described. We conducted a systematic review and meta-analysis of prospective studies examining the association between MSIMI and adverse outcome events in patients with stable CAD. We searched PubMed, EMBASE, Web of Science, and PsycINFO databases for English language prospective studies of patients with CAD who underwent standardized mental stress testing to determine presence of MSIMI and were followed up for subsequent cardiac events or total mortality. Our outcomes of interest were CAD recurrence, CAD mortality, or total mortality. A summary effect estimate was derived using a fixed-effects meta-analysis model. Only 5 studies, each with a sample size of <200 patients and fewer than 50 outcome events, met the inclusion criteria. The pooled samples comprised 555 patients with CAD (85% male) and 117 events with a range of follow-up from 35 days to 8.8 years. Pooled analysis showed that MSIMI was associated with a twofold increased risk of a combined end point of cardiac events or total mortality (relative risk 2.24, 95% confidence interval 1.59 to 3.15). No heterogeneity was detected among the studies (Q=0.39, I2=0.0%, p=0.98). In conclusion, although few selected studies have examined the association between MSIMI and adverse events in patients with CAD, all existing investigations point to approximately a doubling of risk. Whether this increased risk is generalizable to the CAD population at large and varies in patient subgroups warrant further investigation.
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Affiliation(s)
- Jingkai Wei
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Cherie Rooks
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Ronnie Ramadan
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Amit J Shah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; Department of Medicine, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | - J Douglas Bremner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Arshed A Quyyumi
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Michael Kutner
- Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
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Evaluation of mental stress by physiological indices derived from finger plethysmography. J Physiol Anthropol 2013; 32:17. [PMID: 24119254 PMCID: PMC3854451 DOI: 10.1186/1880-6805-32-17] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 09/30/2013] [Indexed: 11/25/2022] Open
Abstract
Background Quantitative evaluation of mental stress is important to prevent stress-related disorders. Finger plethysmography (FPG) is a simple noninvasive method to monitor peripheral circulation, and provides many physiological indices. Our purpose is to investigate how FPG-derived indices reflect on mental stress, and to clarify any association between these physiological indices and subjective indices of mental stress. Methods Thirty-one healthy women (mean age, 22 years ± 2) participated. The participants rested by sitting on a chair for 10 min. They then performed a computerized version of the Stroop color-word conflict test (CWT) for 10 min. Finally, they rested for 10 min. FPG was recorded throughout the experiment. The participants completed a brief form of the Profile of Mood States (POMS) questionnaire before and after the test. Using the FPG data, we conducted chaos analysis and fast Fourier transform analysis, and calculated chaotic attractors, the largest Lyapunov exponent, a high-frequency (HF) component, a low-to-high-frequency (LF/HF) ratio, finger pulse rate and finger pulse wave amplitude. Results The HF component decreased and the LF/HF ratio increased significantly during the test (P < 0.01), while the confusion subscale of POMS increased after the test (P < 0.05). During testing, finger pulse rate significantly increased (P < 0.001), and the finger pulse wave amplitude decreased (P < 0.001). The attractor size reduced during testing and returned to a baseline level afterwards. Although the largest Lyapunov exponent showed no significant change during testing, significant negative correlation with the tension-anxiety subscale of POMS was observed at the beginning (P < 0.01). A significant negative correlation between the LF/HF ratio and two subscales was also observed in the beginning and middle of the test (P < 0.05). There were no correlations during the rest periods. Conclusions The physiological indices derived from FPG were changed by mental stress. Our findings indicate that FPG is one of the easiest methods to evaluate mental stress quantitatively. In particular, the largest Lyapunov exponent and the LF/HF ratio might be associated with acute mental stress. Farther examination is needed to find any association between the physiological indices and various types of mental stress.
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Sciagrà R, Parodi G, Del Pace S, Genovese S, Zampini L, Bellandi B, Gensini GF, Pupi A, Antoniucci D. Abnormal response to mental stress in patients with Takotsubo cardiomyopathy detected by gated single photon emission computed tomography. Eur J Nucl Med Mol Imaging 2010; 37:765-72. [DOI: 10.1007/s00259-009-1362-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Accepted: 12/10/2009] [Indexed: 10/19/2022]
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