Mental Stress-Induced Myocardial Ischemia Detected by Global Longitudinal Strain and Quantitative Myocardial Contrast Echocardiography in Women With Nonobstructive Coronary Artery Disease
The utility of radionuclide myocardial perfusion imaging including positron emission tomography (PET) for diagnosing mental stress-induced myocardial ischemia (MSIMI) is clinically restricted. This study aims to assess the diagnostic performance of novel echocardiographic techniques, including autom...
Gespeichert in:
| Veröffentlicht in: | Journal of the American Society of Echocardiography 2024-09, Vol.37 (9), p.894-905 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 905 |
|---|---|
| container_issue | 9 |
| container_start_page | 894 |
| container_title | Journal of the American Society of Echocardiography |
| container_volume | 37 |
| creator | Kong, Bo Fei, Hongwen Cheng, Shiyao Ma, Huan Yin, Han Li, Mingqi Liu, Quanjun Liu, Yuting Bai, Bingqing Liu, Fengyao Guo, Lan Geng, Qingshan |
| description | The utility of radionuclide myocardial perfusion imaging including positron emission tomography (PET) for diagnosing mental stress-induced myocardial ischemia (MSIMI) is clinically restricted. This study aims to assess the diagnostic performance of novel echocardiographic techniques, including automated strain and quantitative myocardial contrast echocardiography (MCE) with dedicated software and deep neural network model, for MSIMI detection. The secondary objective was to explore the correlation between changes in myocardial blood flow and MSIMI.
Seventy-two female patients ages 18 to 75 with angina and nonobstructive coronary artery disease (ANOCA) and 23 healthy controls were prospectively recruited. Both echocardiography with contrast agent and PET imaging were performed during structured mental stress testing. Mental stress-induced myocardial ischemia was defined as a summed difference score ≥3 on PET. Echocardiographic parameters including left ventricular global longitudinal strain, β, and A × β were obtained, and their trends during mental stress testing were observed. ΔGLS was defined as the ratio of difference between global longitudinal strain values at stress and rest to the rest data. β reserve and A×β reserve were respectively calculated.
Thirty-two ANOCA patients (44%) and 1 control (4%) were diagnosed with MSIMI (P |
| doi_str_mv | 10.1016/j.echo.2024.05.008 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_3056664394</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0894731724002311</els_id><sourcerecordid>3056664394</sourcerecordid><originalsourceid>FETCH-LOGICAL-c356t-79a3125fb9dc59506ab8f1fa2d5e5ad0a5acf944222826c376f79e9f89dd29cf3</originalsourceid><addsrcrecordid>eNp9kc1u1DAQxy1ERZfCC3BAPnJJ6jixE0tcqm1pV9q2QoA4Wo496XqV2IvtVNpn4-XwdgvqiYtH8v9DM_oh9KEiZUUqfr4tQW98SQltSsJKQrpXaFER0Ra8Few1WpBONEVbV-0pehvjlhDCOkLeoNO6a3klunaBft-CS2rE31KAGIuVM7MGg2_3XqtgbFZWUW9gsgpfQgKdstjv8fXo-6ytvXuwaTbWHSuUdVg5g7_OyiWbVLKP8LJr6V02xYSv8uJPn_4hqN1mj3Pwp58gvzZt8J13vo8pzPqpYemDdyrs8UVIkMeljaAivEMngxojvH-eZ-jHl6vvy5tifX-9Wl6sC10znopWqLqibOiF0UwwwlXfDdWgqGHAlCGKKT2IpqGUdpTruuVDK0AMnTCGCj3UZ-jTsXcX_K8ZYpKTjRrGUTnwc5Q1YZzzphZNttKjVQcfY4BB7oKd8uqyIvIATW7lAZo8QJOEyQwthz4-98_9BOZf5C-lbPh8NEC-8tFCkFFbcBmUDRmJNN7-r_8PFxutsA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3056664394</pqid></control><display><type>article</type><title>Mental Stress-Induced Myocardial Ischemia Detected by Global Longitudinal Strain and Quantitative Myocardial Contrast Echocardiography in Women With Nonobstructive Coronary Artery Disease</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Kong, Bo ; Fei, Hongwen ; Cheng, Shiyao ; Ma, Huan ; Yin, Han ; Li, Mingqi ; Liu, Quanjun ; Liu, Yuting ; Bai, Bingqing ; Liu, Fengyao ; Guo, Lan ; Geng, Qingshan</creator><creatorcontrib>Kong, Bo ; Fei, Hongwen ; Cheng, Shiyao ; Ma, Huan ; Yin, Han ; Li, Mingqi ; Liu, Quanjun ; Liu, Yuting ; Bai, Bingqing ; Liu, Fengyao ; Guo, Lan ; Geng, Qingshan</creatorcontrib><description>The utility of radionuclide myocardial perfusion imaging including positron emission tomography (PET) for diagnosing mental stress-induced myocardial ischemia (MSIMI) is clinically restricted. This study aims to assess the diagnostic performance of novel echocardiographic techniques, including automated strain and quantitative myocardial contrast echocardiography (MCE) with dedicated software and deep neural network model, for MSIMI detection. The secondary objective was to explore the correlation between changes in myocardial blood flow and MSIMI.
Seventy-two female patients ages 18 to 75 with angina and nonobstructive coronary artery disease (ANOCA) and 23 healthy controls were prospectively recruited. Both echocardiography with contrast agent and PET imaging were performed during structured mental stress testing. Mental stress-induced myocardial ischemia was defined as a summed difference score ≥3 on PET. Echocardiographic parameters including left ventricular global longitudinal strain, β, and A × β were obtained, and their trends during mental stress testing were observed. ΔGLS was defined as the ratio of difference between global longitudinal strain values at stress and rest to the rest data. β reserve and A×β reserve were respectively calculated.
Thirty-two ANOCA patients (44%) and 1 control (4%) were diagnosed with MSIMI (P < .01). For ANOCA patients with MSIMI, left ventricular GLS, β, and A × β declined to varied extents during mental stress testing compared with those without MSIMI and the controls (P < .05). Bland-Altman plots demonstrated good consistency between β reserve and A × β reserve output by the deep neural network model and iMCE software. Receiver operating characteristic curve analyses showed that ΔGLS, β reserve, and A × β reserve demonstrated favorable ability to predict MSIMI, especially the combination of A × β reserve using iMCE analysis and ΔGLS (area under the curve, 0.94; sensitivity, 83%; specificity, 97%).
Novel technologies in echocardiography exhibit the potential to be a clinical alternative to cardiac PET for effectively detecting MSIMI. Attenuated myocardial blood flow response during structured mental stress testing was correlated with MSIMI, providing a reasonable explanation for the chest discomfort persisting in ANOCA women.
[Display omitted]
•The diagnosis of MSIMI is challenging.•ΔGLS and flow reserve on quantitative MCE could effectively detect MSIMI.•Attenuated flow response during mental stress was correlated with MSIMI.</description><identifier>ISSN: 0894-7317</identifier><identifier>ISSN: 1097-6795</identifier><identifier>EISSN: 1097-6795</identifier><identifier>DOI: 10.1016/j.echo.2024.05.008</identifier><identifier>PMID: 38761987</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adolescent ; Adult ; Aged ; Contrast Media ; Coronary Artery Disease - complications ; Coronary Artery Disease - diagnosis ; Coronary Artery Disease - diagnostic imaging ; Coronary Artery Disease - physiopathology ; Deep neural network ; Echocardiography - methods ; Female ; Global Longitudinal Strain ; Humans ; Mental stress-induced myocardial ischemia ; Middle Aged ; Myocardial blood flow ; Myocardial contrast echocardiography ; Myocardial Ischemia - complications ; Myocardial Ischemia - diagnosis ; Myocardial Ischemia - diagnostic imaging ; Myocardial Ischemia - physiopathology ; Myocardial Perfusion Imaging - methods ; Positron-Emission Tomography - methods ; Prospective Studies ; Stress, Psychological - complications ; Stress, Psychological - physiopathology ; Young Adult</subject><ispartof>Journal of the American Society of Echocardiography, 2024-09, Vol.37 (9), p.894-905</ispartof><rights>2024 American Society of Echocardiography</rights><rights>Copyright © 2024 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c356t-79a3125fb9dc59506ab8f1fa2d5e5ad0a5acf944222826c376f79e9f89dd29cf3</citedby><cites>FETCH-LOGICAL-c356t-79a3125fb9dc59506ab8f1fa2d5e5ad0a5acf944222826c376f79e9f89dd29cf3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0894731724002311$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38761987$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kong, Bo</creatorcontrib><creatorcontrib>Fei, Hongwen</creatorcontrib><creatorcontrib>Cheng, Shiyao</creatorcontrib><creatorcontrib>Ma, Huan</creatorcontrib><creatorcontrib>Yin, Han</creatorcontrib><creatorcontrib>Li, Mingqi</creatorcontrib><creatorcontrib>Liu, Quanjun</creatorcontrib><creatorcontrib>Liu, Yuting</creatorcontrib><creatorcontrib>Bai, Bingqing</creatorcontrib><creatorcontrib>Liu, Fengyao</creatorcontrib><creatorcontrib>Guo, Lan</creatorcontrib><creatorcontrib>Geng, Qingshan</creatorcontrib><title>Mental Stress-Induced Myocardial Ischemia Detected by Global Longitudinal Strain and Quantitative Myocardial Contrast Echocardiography in Women With Nonobstructive Coronary Artery Disease</title><title>Journal of the American Society of Echocardiography</title><addtitle>J Am Soc Echocardiogr</addtitle><description>The utility of radionuclide myocardial perfusion imaging including positron emission tomography (PET) for diagnosing mental stress-induced myocardial ischemia (MSIMI) is clinically restricted. This study aims to assess the diagnostic performance of novel echocardiographic techniques, including automated strain and quantitative myocardial contrast echocardiography (MCE) with dedicated software and deep neural network model, for MSIMI detection. The secondary objective was to explore the correlation between changes in myocardial blood flow and MSIMI.
Seventy-two female patients ages 18 to 75 with angina and nonobstructive coronary artery disease (ANOCA) and 23 healthy controls were prospectively recruited. Both echocardiography with contrast agent and PET imaging were performed during structured mental stress testing. Mental stress-induced myocardial ischemia was defined as a summed difference score ≥3 on PET. Echocardiographic parameters including left ventricular global longitudinal strain, β, and A × β were obtained, and their trends during mental stress testing were observed. ΔGLS was defined as the ratio of difference between global longitudinal strain values at stress and rest to the rest data. β reserve and A×β reserve were respectively calculated.
Thirty-two ANOCA patients (44%) and 1 control (4%) were diagnosed with MSIMI (P < .01). For ANOCA patients with MSIMI, left ventricular GLS, β, and A × β declined to varied extents during mental stress testing compared with those without MSIMI and the controls (P < .05). Bland-Altman plots demonstrated good consistency between β reserve and A × β reserve output by the deep neural network model and iMCE software. Receiver operating characteristic curve analyses showed that ΔGLS, β reserve, and A × β reserve demonstrated favorable ability to predict MSIMI, especially the combination of A × β reserve using iMCE analysis and ΔGLS (area under the curve, 0.94; sensitivity, 83%; specificity, 97%).
Novel technologies in echocardiography exhibit the potential to be a clinical alternative to cardiac PET for effectively detecting MSIMI. Attenuated myocardial blood flow response during structured mental stress testing was correlated with MSIMI, providing a reasonable explanation for the chest discomfort persisting in ANOCA women.
[Display omitted]
•The diagnosis of MSIMI is challenging.•ΔGLS and flow reserve on quantitative MCE could effectively detect MSIMI.•Attenuated flow response during mental stress was correlated with MSIMI.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Contrast Media</subject><subject>Coronary Artery Disease - complications</subject><subject>Coronary Artery Disease - diagnosis</subject><subject>Coronary Artery Disease - diagnostic imaging</subject><subject>Coronary Artery Disease - physiopathology</subject><subject>Deep neural network</subject><subject>Echocardiography - methods</subject><subject>Female</subject><subject>Global Longitudinal Strain</subject><subject>Humans</subject><subject>Mental stress-induced myocardial ischemia</subject><subject>Middle Aged</subject><subject>Myocardial blood flow</subject><subject>Myocardial contrast echocardiography</subject><subject>Myocardial Ischemia - complications</subject><subject>Myocardial Ischemia - diagnosis</subject><subject>Myocardial Ischemia - diagnostic imaging</subject><subject>Myocardial Ischemia - physiopathology</subject><subject>Myocardial Perfusion Imaging - methods</subject><subject>Positron-Emission Tomography - methods</subject><subject>Prospective Studies</subject><subject>Stress, Psychological - complications</subject><subject>Stress, Psychological - physiopathology</subject><subject>Young Adult</subject><issn>0894-7317</issn><issn>1097-6795</issn><issn>1097-6795</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc1u1DAQxy1ERZfCC3BAPnJJ6jixE0tcqm1pV9q2QoA4Wo496XqV2IvtVNpn4-XwdgvqiYtH8v9DM_oh9KEiZUUqfr4tQW98SQltSsJKQrpXaFER0Ra8Few1WpBONEVbV-0pehvjlhDCOkLeoNO6a3klunaBft-CS2rE31KAGIuVM7MGg2_3XqtgbFZWUW9gsgpfQgKdstjv8fXo-6ytvXuwaTbWHSuUdVg5g7_OyiWbVLKP8LJr6V02xYSv8uJPn_4hqN1mj3Pwp58gvzZt8J13vo8pzPqpYemDdyrs8UVIkMeljaAivEMngxojvH-eZ-jHl6vvy5tifX-9Wl6sC10znopWqLqibOiF0UwwwlXfDdWgqGHAlCGKKT2IpqGUdpTruuVDK0AMnTCGCj3UZ-jTsXcX_K8ZYpKTjRrGUTnwc5Q1YZzzphZNttKjVQcfY4BB7oKd8uqyIvIATW7lAZo8QJOEyQwthz4-98_9BOZf5C-lbPh8NEC-8tFCkFFbcBmUDRmJNN7-r_8PFxutsA</recordid><startdate>20240901</startdate><enddate>20240901</enddate><creator>Kong, Bo</creator><creator>Fei, Hongwen</creator><creator>Cheng, Shiyao</creator><creator>Ma, Huan</creator><creator>Yin, Han</creator><creator>Li, Mingqi</creator><creator>Liu, Quanjun</creator><creator>Liu, Yuting</creator><creator>Bai, Bingqing</creator><creator>Liu, Fengyao</creator><creator>Guo, Lan</creator><creator>Geng, Qingshan</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20240901</creationdate><title>Mental Stress-Induced Myocardial Ischemia Detected by Global Longitudinal Strain and Quantitative Myocardial Contrast Echocardiography in Women With Nonobstructive Coronary Artery Disease</title><author>Kong, Bo ; Fei, Hongwen ; Cheng, Shiyao ; Ma, Huan ; Yin, Han ; Li, Mingqi ; Liu, Quanjun ; Liu, Yuting ; Bai, Bingqing ; Liu, Fengyao ; Guo, Lan ; Geng, Qingshan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c356t-79a3125fb9dc59506ab8f1fa2d5e5ad0a5acf944222826c376f79e9f89dd29cf3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Contrast Media</topic><topic>Coronary Artery Disease - complications</topic><topic>Coronary Artery Disease - diagnosis</topic><topic>Coronary Artery Disease - diagnostic imaging</topic><topic>Coronary Artery Disease - physiopathology</topic><topic>Deep neural network</topic><topic>Echocardiography - methods</topic><topic>Female</topic><topic>Global Longitudinal Strain</topic><topic>Humans</topic><topic>Mental stress-induced myocardial ischemia</topic><topic>Middle Aged</topic><topic>Myocardial blood flow</topic><topic>Myocardial contrast echocardiography</topic><topic>Myocardial Ischemia - complications</topic><topic>Myocardial Ischemia - diagnosis</topic><topic>Myocardial Ischemia - diagnostic imaging</topic><topic>Myocardial Ischemia - physiopathology</topic><topic>Myocardial Perfusion Imaging - methods</topic><topic>Positron-Emission Tomography - methods</topic><topic>Prospective Studies</topic><topic>Stress, Psychological - complications</topic><topic>Stress, Psychological - physiopathology</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kong, Bo</creatorcontrib><creatorcontrib>Fei, Hongwen</creatorcontrib><creatorcontrib>Cheng, Shiyao</creatorcontrib><creatorcontrib>Ma, Huan</creatorcontrib><creatorcontrib>Yin, Han</creatorcontrib><creatorcontrib>Li, Mingqi</creatorcontrib><creatorcontrib>Liu, Quanjun</creatorcontrib><creatorcontrib>Liu, Yuting</creatorcontrib><creatorcontrib>Bai, Bingqing</creatorcontrib><creatorcontrib>Liu, Fengyao</creatorcontrib><creatorcontrib>Guo, Lan</creatorcontrib><creatorcontrib>Geng, Qingshan</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American Society of Echocardiography</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kong, Bo</au><au>Fei, Hongwen</au><au>Cheng, Shiyao</au><au>Ma, Huan</au><au>Yin, Han</au><au>Li, Mingqi</au><au>Liu, Quanjun</au><au>Liu, Yuting</au><au>Bai, Bingqing</au><au>Liu, Fengyao</au><au>Guo, Lan</au><au>Geng, Qingshan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Mental Stress-Induced Myocardial Ischemia Detected by Global Longitudinal Strain and Quantitative Myocardial Contrast Echocardiography in Women With Nonobstructive Coronary Artery Disease</atitle><jtitle>Journal of the American Society of Echocardiography</jtitle><addtitle>J Am Soc Echocardiogr</addtitle><date>2024-09-01</date><risdate>2024</risdate><volume>37</volume><issue>9</issue><spage>894</spage><epage>905</epage><pages>894-905</pages><issn>0894-7317</issn><issn>1097-6795</issn><eissn>1097-6795</eissn><abstract>The utility of radionuclide myocardial perfusion imaging including positron emission tomography (PET) for diagnosing mental stress-induced myocardial ischemia (MSIMI) is clinically restricted. This study aims to assess the diagnostic performance of novel echocardiographic techniques, including automated strain and quantitative myocardial contrast echocardiography (MCE) with dedicated software and deep neural network model, for MSIMI detection. The secondary objective was to explore the correlation between changes in myocardial blood flow and MSIMI.
Seventy-two female patients ages 18 to 75 with angina and nonobstructive coronary artery disease (ANOCA) and 23 healthy controls were prospectively recruited. Both echocardiography with contrast agent and PET imaging were performed during structured mental stress testing. Mental stress-induced myocardial ischemia was defined as a summed difference score ≥3 on PET. Echocardiographic parameters including left ventricular global longitudinal strain, β, and A × β were obtained, and their trends during mental stress testing were observed. ΔGLS was defined as the ratio of difference between global longitudinal strain values at stress and rest to the rest data. β reserve and A×β reserve were respectively calculated.
Thirty-two ANOCA patients (44%) and 1 control (4%) were diagnosed with MSIMI (P < .01). For ANOCA patients with MSIMI, left ventricular GLS, β, and A × β declined to varied extents during mental stress testing compared with those without MSIMI and the controls (P < .05). Bland-Altman plots demonstrated good consistency between β reserve and A × β reserve output by the deep neural network model and iMCE software. Receiver operating characteristic curve analyses showed that ΔGLS, β reserve, and A × β reserve demonstrated favorable ability to predict MSIMI, especially the combination of A × β reserve using iMCE analysis and ΔGLS (area under the curve, 0.94; sensitivity, 83%; specificity, 97%).
Novel technologies in echocardiography exhibit the potential to be a clinical alternative to cardiac PET for effectively detecting MSIMI. Attenuated myocardial blood flow response during structured mental stress testing was correlated with MSIMI, providing a reasonable explanation for the chest discomfort persisting in ANOCA women.
[Display omitted]
•The diagnosis of MSIMI is challenging.•ΔGLS and flow reserve on quantitative MCE could effectively detect MSIMI.•Attenuated flow response during mental stress was correlated with MSIMI.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>38761987</pmid><doi>10.1016/j.echo.2024.05.008</doi><tpages>12</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0894-7317 |
| ispartof | Journal of the American Society of Echocardiography, 2024-09, Vol.37 (9), p.894-905 |
| issn | 0894-7317 1097-6795 1097-6795 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_3056664394 |
| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Adolescent Adult Aged Contrast Media Coronary Artery Disease - complications Coronary Artery Disease - diagnosis Coronary Artery Disease - diagnostic imaging Coronary Artery Disease - physiopathology Deep neural network Echocardiography - methods Female Global Longitudinal Strain Humans Mental stress-induced myocardial ischemia Middle Aged Myocardial blood flow Myocardial contrast echocardiography Myocardial Ischemia - complications Myocardial Ischemia - diagnosis Myocardial Ischemia - diagnostic imaging Myocardial Ischemia - physiopathology Myocardial Perfusion Imaging - methods Positron-Emission Tomography - methods Prospective Studies Stress, Psychological - complications Stress, Psychological - physiopathology Young Adult |
| title | Mental Stress-Induced Myocardial Ischemia Detected by Global Longitudinal Strain and Quantitative Myocardial Contrast Echocardiography in Women With Nonobstructive Coronary Artery Disease |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-13T00%3A51%3A48IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Mental%20Stress-Induced%20Myocardial%20Ischemia%20Detected%20by%20Global%20Longitudinal%20Strain%20and%20Quantitative%20Myocardial%20Contrast%20Echocardiography%20in%20Women%20With%20Nonobstructive%20Coronary%20Artery%20Disease&rft.jtitle=Journal%20of%20the%20American%20Society%20of%20Echocardiography&rft.au=Kong,%20Bo&rft.date=2024-09-01&rft.volume=37&rft.issue=9&rft.spage=894&rft.epage=905&rft.pages=894-905&rft.issn=0894-7317&rft.eissn=1097-6795&rft_id=info:doi/10.1016/j.echo.2024.05.008&rft_dat=%3Cproquest_cross%3E3056664394%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=3056664394&rft_id=info:pmid/38761987&rft_els_id=S0894731724002311&rfr_iscdi=true |