Association between anxiety disorder and the extent of ischemia observed in cardiac syndrome X

J Nucl Cardiol. 2009 May-Jun;16(3):405-10. doi: 10.1007/s12350-008-9032-2. Epub 2009 Jan 22.


Background: A possible link between the heart and brain has been reported for cardiac syndrome X. Anxiety disorder could be a pathophysiological mechanism for this cardiac chest pain. To the authors' knowledge, a quantitative analysis correlating anxiety with the extent of ischemia has not been done.

Methods and results: In this pilot study, we evaluated 20 patients with typical chest pain and completely normal coronary angiograms. These patients were screened with the State Scale and Trait Scale of the State-Trait Anxiety Inventory (STAI). All patients underwent myocardial perfusion scintigraphic imaging. The scintigrams were scored by three experienced readers having no knowledge of the STAI screening results. Patients with a low trait anxiety had significantly less ischemic segments on the myocardial perfusion imaging than patients with a high trait anxiety (1.8 +/- 1.9 vs 3.5 +/- 0.6, P < .05). For state anxiety, no significant differences could be found.

Conclusion: Cardiac syndrome X patients with high trait anxiety are at risk of having more ischemia.

MeSH terms

  • Anxiety / complications*
  • Anxiety / diagnostic imaging*
  • Chest Pain
  • Female
  • Humans
  • Male
  • Microvascular Angina / complications*
  • Microvascular Angina / diagnostic imaging*
  • Middle Aged
  • Myocardial Ischemia / complications*
  • Myocardial Ischemia / diagnostic imaging*
  • Pilot Projects
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Tomography, Emission-Computed, Single-Photon / methods*