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To the Editor Recent research on mental stress–induced myocardial ischemia (MSIMI) has been devoted to pathophysiology, prognosis, and intervention, the latter being the focus of the Responses of Mental Stress Induced Myocardial Ischemia to Escitalopram Treatment (REMIT) trial.1 Aside from the early work of Deanfield et al,2 researchers have mostly used secondary markers of ischemia (eg, left ventricular [LV] dysfunction) rather than directly assessing myocardial blood flow. The REMIT trial also used secondary indices (wall motion and LV dysfunction), which is unfortunate because more recent research has shown these to lack the sensitivity and specificity of single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) for the assessment of ischemia provoked by mental stress.3
Burg MM, Soufer R. Therapy for Mental Stress–Induced Myocardial Ischemia. JAMA. 2013;310(13):1400-1401. doi:10.1001/jama.2013.277951