{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T04:56:50Z","timestamp":1782449810940,"version":"3.54.5"},"reference-count":44,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Imaging"],"published-print":{"date-parts":[[2020,8]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>The inferior frontal lobe is an important area of the brain involved in the stress response, and higher activation with acute mental stress may indicate a more severe stress reaction. However, it is unclear if activation of this region with stress correlates with angina in individuals with coronary artery disease.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>Individuals with stable coronary artery disease underwent acute mental stress testing using a series of standardized speech\/arithmetic stressors in conjunction with high resolution positron emission tomography imaging of the brain. Blood flow to the inferior frontal lobe was evaluated as a ratio compared with whole brain flow for each scan. Angina was assessed with the Seattle Angina Questionnaire\u2019s angina frequency subscale at baseline and 2 years follow-up.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>\n              We analyzed 148 individuals with coronary artery disease (mean age [SD] 62 [8] years; 69% male, and 35.8% Black). For every doubling in the inferior frontal lobe activation, angina frequency was increased by 13.7 units at baseline (\n              <jats:inline-graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"CIRCIMAGING.120.010710.eq01.tif\"\/>\n              , 13.7 [95% CI, 6.3\u201321.7];\n              <jats:italic>P<\/jats:italic>\n              =0.008) and 11.6 units during follow-up (\n              <jats:inline-graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"CIRCIMAGING.120.010710.eq02.tif\"\/>\n              , 11.6 [95% CI, 4.1\u201319.2];\n              <jats:italic>P<\/jats:italic>\n              =0.01) in a model adjusted for baseline demographics. Mental stress-induced ischemia and activation of other brain pain processing regions (thalamus, insula, and amygdala) accounted for 40.0% and 13.1% of the total effect of inferior frontal lobe activation on angina severity, respectively.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Inferior frontal lobe activation with mental stress is independently associated with angina at baseline and during follow-up. Mental stress-induced ischemia and other pain processing brain regions may play a contributory role.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circimaging.120.010710","type":"journal-article","created":{"date-parts":[[2020,8,10]],"date-time":"2020-08-10T09:00:21Z","timestamp":1597050021000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":20,"title":["Association Between Mental Stress-Induced Inferior Frontal Cortex Activation and Angina in Coronary Artery Disease"],"prefix":"10.1161","volume":"13","author":[{"given":"Kasra","family":"Moazzami","sequence":"first","affiliation":[{"name":"Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (K.M., B.B.L., V.V., A.J.S.)."},{"name":"Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine (K.M., M.A., B.B.L., P.K.M., A.A.Q., A.J.S.), Emory University School of Medicine, Atlanta, GA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew T.","family":"Wittbrodt","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences (M.T.W., J.D.B.), Emory University School of Medicine, Atlanta, GA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mhmtjamil","family":"Alkhalaf","sequence":"additional","affiliation":[{"name":"Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine (K.M., M.A., B.B.L., P.K.M., A.A.Q., A.J.S.), Emory University School of Medicine, Atlanta, GA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno B.","family":"Lima","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (K.M., B.B.L., V.V., A.J.S.)."},{"name":"Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine (K.M., M.A., B.B.L., P.K.M., A.A.Q., A.J.S.), Emory University School of Medicine, Atlanta, GA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathon A.","family":"Nye","sequence":"additional","affiliation":[{"name":"Department of Radiology and Imaging Sciences (J.A.N., J.D.B.), Emory University School of Medicine, Atlanta, GA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Puja K.","family":"Mehta","sequence":"additional","affiliation":[{"name":"Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine (K.M., M.A., B.B.L., P.K.M., A.A.Q., A.J.S.), Emory University School of Medicine, Atlanta, GA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arshed A.","family":"Quyyumi","sequence":"additional","affiliation":[{"name":"Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine (K.M., M.A., B.B.L., P.K.M., A.A.Q., A.J.S.), Emory University School of Medicine, Atlanta, GA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viola","family":"Vaccarino","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (K.M., B.B.L., V.V., A.J.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. 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