Mental stress ischemia: Present status and future goals

A body of research published over the past 20 years has revealed much concerning the prevalence, pathophysiology, and prognosis associated with MSI while also providing promising approaches to improving event-free survival rates in those who have this form of ischemia. Although many important questions remain, we believe that the findings to date provide sufficient evidence for the planning, development, and execution of a large-scale clinical trial. Such a trial would provide for not only further testing of prognostic significance and treatment effects but also explorations into important remaining questions of pathophysiology while elaborating possible additional modalities for treatment. Our collective expertise in nuclear cardiology provides an opportunity to establish the diagnostic standardization, approach, and assessment of prognosis and treatment. We are in a position to be thought leaders of a complex clinical manifestation of ischemia that has substantial clinical impact.