Comment & Response |

Therapy for Mental Stress–Induced Myocardial Ischemia—Reply

Wei Jiang, MD1; Christopher M. O’Connor, MD1; Eric J. Velazquez, MD1
[+] Author Affiliations
1Duke University Medical Center, Durham, North Carolina
JAMA. 2013;310(13):1401-1402. doi:10.1001/jama.2013.277975.
Text Size: A A A
Published online


In Reply We agree that the REMIT trial cannot answer the question raised by Drs Burg and Soufer about the effect of escitalopram on vascular processes leading to MSIMI because the study was primarily designed to test whether escitalopram would improve MSIMI compared with placebo.

There were several reasons echocardiography was chosen over SPECT MPI for this study. First, mental stress–induced wall motion abnormality and significant reduction of LVEF (≥5%) are well accepted as evidence of MSIMI.1 Second, stress-induced LVEF reduction may be related to subendocardial hypoperfusion,2 which may not be optimally detected by SPECT MPI. Even though SPECT MPI represents a well-established technique, it has lower specificity compared with echocardiography for stress-induced ischemia.3 In addition, comparison studies of echocardiography and SPECT MPI on sensitivity and specificity in relation to MSIMI are limited. Third, another main disadvantage of SPECT MPI is that patients are exposed to diagnostic levels of radiation that would be considered an unacceptable risk.


Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
First page PDF preview




October 2, 2013
Matthew M. Burg, PhD; Robert Soufer, MD
1Department of Medicine, Columbia University Medical Center, New York, New York
2Department of Medicine, Yale University Medical School, New Haven, Connecticut
JAMA. 2013;310(13):1400-1401. doi:10.1001/jama.2013.277951.
October 2, 2013
Arthur Shiyovich, MD
1Department of Internal Medicine, Soroka University Medical Center, Beer Sheva, Israel
JAMA. 2013;310(13):1401. doi:10.1001/jama.2013.277966.
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Related Topics