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Table 2 The details of diagnostic methods

From: A meta-analysis on the prevalence, associated factors and diagnostic methods of mental stress induced myocardial ischemia

Diagnostic methods Types Details
Mental stress Mental arithmetic Participants were required to complete a series of mathematical calculation, for instance, to subtract 7 from a 4-digit number in 5 min as quickly as possible, at the same time, they would receive encouragement or discouragement from the investigators
Public speaking Participants were asked to give a speech on a topic given by the investigators, and they had 2 min to prepare and 3 min to deliver the speech. They were told that their speech would be recorded and evaluated by the investigators
Mirror trace Participants were instructed to outline the shape of a star from its reflection in a mirror
Stroop color word task Participants were showing a series of slides which displaying the written word of a non-matching color (e.g. the word green in blue color)
Anger recall Participants were asked to recall a recent annoying event which made them feel angry, upset, irritated, frustrated, then described the situation and feeling to the investigators in details
Reading Participants were asked to read a passage given by the investigators, such as neutral passage, in front of the investigators
Type A structured interview Participants underwent a standard videotaped interview to assess type A behavior which might last 20 min
Competitive computer game Participants were asked to play a kind of computer game, which might elicit threat, uncertainty, and avoidance.
Diagnostic techniques SPECT [99mTc] sestamibi SPECT was used to acquire myocardial perfusion imaging at rest and during mental stress
RNV R-wave synchronized, multiple-gated RNV was conducted with a gamma camera positioned in the left anterior oblique angle, to acquire LVEF and left ventricular wall motion
ECG/Ambulatory ECG 12 lead ECG or an ambulatory ECG was used for recording ST segments
Echocardiography Two dimensional echocardiography was used to assess regional wall motion and LVEF
Diagnostic measurements LVEF decrease A reduction of LVEF at least 5% or 8% during mental stress compared with rest LVEF was considered to exhibit MSIMI
WMA New or worsened wall motion abnormalities during mental stress when compared with rest
ST depression At least 1 mm ST segment depression by ECG or ambulatory ECG
MPD A 17-segment model was used to assess the myocardial perfusion defects comparing rest and mental stress images, The following considerations could be regarded as MSIMI: a new myocardial perfusion defect with a score of 2 in any segment, or worsening of a preexisting impairment of at least 2 points in a single segment, or worsening of at least 1 point in 2 or more contiguous segments
  1. MPD myocardial perfusion defects, WMA wall motion abnormality, LVEF left ventricle ejection fraction, RNV radionuclide ventriculography, ECG electrocardiography, MPD myocardial perfusion defects, SPECT single photon emission computed tomography, MSIMI mental stress induced myocardial ischemia