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Robert Soufer, MD

Professor of Medicine (Cardiology); Vice Chair for Clinical Research, Department of Internal Medicine; Associate Chair of Medicine for Faculty Development, Medicine

Contact Information

Robert Soufer, MD

Mailing Address

  • Internal Medicine

    PO Box 208056, 333 Cedar Street

    New Haven, CT 06520-8056

    United States

Research Summary

Dr. Soufer’s research effort deals with the elucidation of the interaction between the brain and the heart. His research integrates Cardiology, Neurobiology, Psychology and Nuclear Medicine. Specifically, he and his colleagues have elucidated Brain and Heart interactions of emotion and stress culminating in progressive myocardial ischemia (“low blood flow”) resulting in myocardial infarction (“heart attack”). His research efforts aresingular in methodology which simultaneously measures brain activation and myocardial perfusion and function with Positron Emission Tomography during a laboratory stress intervention. His group was the first to establish specific brain activation patterns associated with myocardial ischemia, which results from emotional provocation.

Specialized Terms: Neurobehavioral Correlates of Mental Stress in Cardiovascular Disease; Neuro-Cardiac Interaction; Mental Stress; Myocardial Blood Flow

Extensive Research Description

Data show that psychological factors play an important role in acute coronary syndromes. We and others, have found mentally demanding tasks such as mental arithmetic to provoke ischemia in approximately 50% of patients with ischemic heart disease. We have also found a specific psychological profile, characterized by emotional reactivity, and easily aroused anger and hostility, to be associated with this “mental stress ischemia”; conversely, we have not found an association between this profile and exercise ischemia. Follow up of these mental stress positive patients reveal a significantly poorer 1-2 year prognosis. Hence, mental stress ischemia may be a distinct phenomenon with unique risk factors and prognosis. The mechanisms of mental stress ischemia are, however, not well understood. Critical questions remain regarding the ways by which mental and psychological factors contribute to coronary syndromes. We believe that psychological, neurobiological and coronary vasomotor processes are key factors, expanding upon our pilot work, conducted in the context of our current funding. We are examining the functional CNS correlates of mental stress ischemia; these CNS correlates will be defined by positron emission tomography (PET) conducted while patients perform an arithmetic task that we have found to reliably provoke ischemia in half of those we have studied. This approach will illuminate CNS processes that may be serving to transduce mental stress susceptibility into risk for acute coronary events. Specific issues concerning gender interaction and relationship to psychological profiles/coping styles are currently being explored.

The overarching research theme of our research is the elucidation of those mechanisms, which transduce cognitive stress as a provocation of myocardial ischemia. Specifically, we are interested in the neurobiology and coronary flow dynamics that results from mentally stressful tasks. Our work utilizes simultaneous measurements of brain activation and myocardial function/coronary flow with PET imaging, echocardiography and pulse arterial tonometry during laboratory mental stress. We are developing conceptual constructs based upon our previous work, which support a model that suggests certain regional and global brain activation maps are associated with coronary flow responses specific to psychosocial stress.

Our goal for the next academic year is to describe the pathophysiologic mechanisms of mental stress induced myocardial ischemia that differs from those that are a result of exercise. We have the largest series of subjects to date (n=138) undergoing simultaneous imaging with PET during Mental Stress and then again with dobutamine as a surrogate for exercise in a population of CAD subjects. Our results thus far support our hypothesis of regional activation in the brain that promote parasympathetic withdrawal, increase in sympathetic tone and decrease LV flow/ function that is not observed in the dobutamine group (exercise surrogate) is thus far confirmed. A manuscript based on these results is in preparation. We have studies that show a gender interaction that has just been analyzed and these data will be prepared and submitted afterwards.

An individual’s biological substrate interacts within this neurobehavioral context thru genetic, endocrine, immune and neural processes. Many of these processes are shape by inflammatory responses. Our previous published reports reinforced the principle that inflammatory processes may also be associated with other dimensions of CAD expression. In this past year we have expanded our constructs regarding the role of other vascular factors, which may be operative during Mental Stress Ischemia. Specifically our recent data suggests an up regulation of ET-1 among CAD patients who are subjected to a standardized Anger recall paradigm. We have also described these findings in the context of the parasympathetic inflammatory response, which predicts such increases in response to w withdrawal of parasympathetic tone, a cardinal feature of Mental Stress Induced Myocardial Ischemia. We have observed an inverse relationship of TNF-alpha and parasympathetic withdrawal in subjects who become ischemic and have specific regional brain activation coincident with this process. Finally, we have developed and published a noninvasive stress test to index those most vulnerable to Mental Stress Ischemia.

Title: Depression and Coronary Disease: Prognosis and Mechanisms.The objectives of this project are to explore prognosis in subjects with CAD and depression after percutaneous intervention.

Title: Neurobehavioral Correlates of Mental Stress Ischemia. The objectives of this project are to examine CNS involvement in mental stress ischemia, using a combination of modalities, including positron emission tomography and echocardiography.

Title: Neurobehavioral Correlates of Mental Stress Ischemia: Supplement for Serological Core Lab.
The objectives of this project are to examine the inflammatory underpinnings of MSI.

Coauthors

Research Interests

Cardiology; Cardiovascular Diseases; Neurobiology; Nuclear Medicine; Stress, Psychological; Neurobehavioral Manifestations

Selected Publications

  • Cardiovascular Imaging of Biology and Emotion: Considerations Toward a New Paradigm.Meadows JL, Shah S, Burg MM, Pfau S, Soufer R. Cardiovascular Imaging of Biology and Emotion: Considerations Toward a New Paradigm. Circulation. Cardiovascular Imaging 2020, 13: e011054. PMID: 32762255, PMCID: PMC9261020, DOI: 10.1161/CIRCIMAGING.120.011054.
  • Relationship Between Depressive Symptoms and Health Status in Peripheral Artery Disease: Role of Sex Differences.Jelani QU, Mena-Hurtado C, Burg M, Soufer R, Gosch K, Jones PG, Spertus JA, Safdar B, Smolderen KG. Relationship Between Depressive Symptoms and Health Status in Peripheral Artery Disease: Role of Sex Differences. Journal Of The American Heart Association 2020, 9: e014583. PMID: 32781883, PMCID: PMC7660812, DOI: 10.1161/JAHA.119.014583.
  • Effect of β-blockers on triggering of symptomatic atrial fibrillation by anger or stress.Lampert R, Burg MM, Jamner LD, Dziura J, Brandt C, Li F, Donovan T, Soufer R. Effect of β-blockers on triggering of symptomatic atrial fibrillation by anger or stress. Heart Rhythm : The Official Journal Of The Heart Rhythm Society 2019, 16: 1167-1173. PMID: 31171436, PMCID: PMC6759206, DOI: 10.1016/j.hrthm.2019.03.004.
  • Rac2 Modulates Atherosclerotic Calcification by Regulating Macrophage Interleukin-1β Production.Ceneri N, Zhao L, Young BD, Healy A, Coskun S, Vasavada H, Yarovinsky TO, Ike K, Pardi R, Qin L, Qin L, Tellides G, Hirschi K, Meadows J, Soufer R, Chun HJ, Sadeghi M, Bender JR, Morrison AR. Rac2 Modulates Atherosclerotic Calcification by Regulating Macrophage Interleukin-1β Production. Arteriosclerosis, Thrombosis, And Vascular Biology 2017, 37: 328-340. PMID: 27834690, PMCID: PMC5269510, DOI: 10.1161/ATVBAHA.116.308507.
  • The interface of emotion and biology in myocardial ischemia: Can we progress using the traditional paradigm?Soufer R, Burg MM. The interface of emotion and biology in myocardial ischemia: Can we progress using the traditional paradigm? Journal Of Nuclear Cardiology : Official Publication Of The American Society Of Nuclear Cardiology 2017, 24: 783-787. PMID: 28155190, DOI: 10.1007/s12350-016-0762-2.
  • Post-traumatic Stress Disorder and Cardiovascular Disease.Burg MM, Soufer R. Post-traumatic Stress Disorder and Cardiovascular Disease. Current Cardiology Reports 2016, 18: 94. PMID: 27566327, DOI: 10.1007/s11886-016-0770-5.
  • Body Mass Index and Risk for Mental Stress Induced Ischemia in Coronary Artery Disease.Soufer R, Fernandez AB, Meadows J, Collins D, Burg MM. Body Mass Index and Risk for Mental Stress Induced Ischemia in Coronary Artery Disease. Molecular Medicine (Cambridge, Mass.) 2016, 22: 286-291. PMID: 27261777, PMCID: PMC5023512, DOI: 10.2119/molmed.2016.00128.
  • Triggering of symptomatic atrial fibrillation by negative emotion.Lampert R, Jamner L, Burg M, Dziura J, Brandt C, Liu H, Li F, Donovan T, Soufer R. Triggering of symptomatic atrial fibrillation by negative emotion. Journal Of The American College Of Cardiology 2014, 64: 1533-4. PMID: 25277622, DOI: 10.1016/j.jacc.2014.07.959.
  • Confluence of depression and acute psychological stress among patients with stable coronary heart disease: effects on myocardial perfusion.Burg MM, Meadows J, Shimbo D, Davidson KW, Schwartz JE, Soufer R. Confluence of depression and acute psychological stress among patients with stable coronary heart disease: effects on myocardial perfusion. Journal Of The American Heart Association 2014, 3: e000898. PMID: 25359402, PMCID: PMC4338683, DOI: 10.1161/JAHA.114.000898.
  • Psychological Stress and Induced Ischemic Syndromes.Burg MM, Soufer R. Psychological Stress and Induced Ischemic Syndromes. Current Cardiovascular Risk Reports 2014, 8: 377. PMID: 24860639, PMCID: PMC4030631, DOI: 10.1007/s12170-014-0377-6.
  • Therapy for mental stress-induced myocardial ischemia.Burg MM, Soufer R. Therapy for mental stress-induced myocardial ischemia. JAMA 2013, 310: 1400-1. PMID: 24084926, DOI: 10.1001/jama.2013.277951.
  • Autonomic contribution to endothelin-1 increase during laboratory anger-recall stress in patients with coronary artery disease.Burg MM, Soufer A, Lampert R, Collins D, Soufer R. Autonomic contribution to endothelin-1 increase during laboratory anger-recall stress in patients with coronary artery disease. Molecular Medicine (Cambridge, Mass.) 2011, 17: 495-501. PMID: 21267513, PMCID: PMC3105151, DOI: 10.2119/molmed.2010.00083.
  • Cardiac repolarization instability during psychological stress in patients with ventricular arrhythmias.Abisse SS, Lampert R, Burg M, Soufer R, Shusterman V. Cardiac repolarization instability during psychological stress in patients with ventricular arrhythmias. Journal Of Electrocardiology 2011, 44: 678-83. PMID: 21920534, PMCID: PMC3200452, DOI: 10.1016/j.jelectrocard.2011.07.019.
  • Depression predicts elevated endothelin-1 in patients with coronary artery disease.Burg MM, Martens EJ, Collins D, Soufer R. Depression predicts elevated endothelin-1 in patients with coronary artery disease. Psychosomatic Medicine 2011, 73: 2-6. PMID: 20947777, PMCID: PMC3016462, DOI: 10.1097/PSY.0b013e3181fdfb25.
  • Mechanistic and Methodological Considerations for the Imaging of Mental Stress Ischemia. Chapter in Clinical Nuclear Cardiology: State of the Art and Future Directions, 4rd Edition.Soufer R, Burg M, Fernandez A. Mechanistic and Methodological Considerations for the Imaging of Mental Stress Ischemia. Chapter in Clinical Nuclear Cardiology: State of the Art and Future Directions, 4rd Edition, 2010; Ed Zaret and Beller.
  • Tendency to angry rumination predicts stress-provoked endothelin-1 increase in patients with coronary artery disease.Fernandez AB, Soufer R, Collins D, Soufer A, Ranjbaran H, Burg MM. Tendency to angry rumination predicts stress-provoked endothelin-1 increase in patients with coronary artery disease. Psychosomatic Medicine 2010, 72: 348-53. PMID: 20368479, PMCID: PMC2872076, DOI: 10.1097/PSY.0b013e3181d71982.
  • Anger-induced T-wave alternans predicts future ventricular arrhythmias in patients with implantable cardioverter-defibrillators.Lampert R, Shusterman V, Burg M, McPherson C, Batsford W, Goldberg A, Soufer R. Anger-induced T-wave alternans predicts future ventricular arrhythmias in patients with implantable cardioverter-defibrillators. Journal Of The American College Of Cardiology 2009, 53: 774-8. PMID: 19245968, PMCID: PMC3979284, DOI: 10.1016/j.jacc.2008.10.053.
  • Noninvasive detection of risk for emotion-provoked myocardial ischemia.Burg MM, Graeber B, Vashist A, Collins D, Earley C, Liu J, Lampert R, Soufer R. Noninvasive detection of risk for emotion-provoked myocardial ischemia. Psychosomatic Medicine 2009, 71: 14-20. PMID: 18941131, PMCID: PMC2739989, DOI: 10.1097/PSY.0b013e318187c035.
  • Heart-brain interactions in mental stress-induced myocardial ischemia.Soufer R, Jain H, Yoon AJ. Heart-brain interactions in mental stress-induced myocardial ischemia. Current Cardiology Reports 2009, 11: 133-40. PMID: 19236829, PMCID: PMC3726062, DOI: 10.1007/s11886-009-0020-1.
  • Psychological stress and myocardial ischemia: understanding the link and the implications.Sheps DS, Soufer R, Freedland KE. Psychological stress and myocardial ischemia: understanding the link and the implications. Psychosomatic Medicine 2007, 69: 491-2. PMID: 17641143, DOI: 10.1097/PSY.0b013e31814527c2.
  • Mental stress-induced myocardial ischemia: moving forward.Burg MM, Soufer R. Mental stress-induced myocardial ischemia: moving forward. Journal Of Nuclear Cardiology : Official Publication Of The American Society Of Nuclear Cardiology 2007, 14: 269-71. PMID: 17556157, DOI: 10.1016/j.nuclcard.2007.04.009.
  • Implantable cardioverter-defibrillator shocks increase T-wave alternans.Lampert R, Soufer R, McPherson CA, Batsford WP, Tirado S, Earley C, Goldberg A, Shusterman V. Implantable cardioverter-defibrillator shocks increase T-wave alternans. Journal Of Cardiovascular Electrophysiology 2007, 18: 512-7. PMID: 17428273, DOI: 10.1111/j.1540-8167.2007.00787.x.
  • The heart-brain interaction during emotionally provoked myocardial ischemia: implications of cortical hyperactivation in CAD and gender interactions.Soufer R, Burg MM. The heart-brain interaction during emotionally provoked myocardial ischemia: implications of cortical hyperactivation in CAD and gender interactions. Cleveland Clinic Journal Of Medicine 2007, 74 Suppl 1: S59-62. PMID: 17455547, DOI: 10.3949/ccjm.74.suppl_1.s59.
  • C-reactive protein and vulnerability to mental stress-induced myocardial ischemia.Shah R, Burg MM, Vashist A, Collins D, Liu J, Jadbabaie F, Graeber B, Earley C, Lampert R, Soufer R. C-reactive protein and vulnerability to mental stress-induced myocardial ischemia. Molecular Medicine (Cambridge, Mass.) 2006, 12: 269-74. PMID: 17380191, PMCID: PMC1829194, DOI: 10.2119/2006–00077.Shah.
  • Effects of psychologic stress on repolarization and relationship to autonomic and hemodynamic factors.Lampert R, Shusterman V, Burg MM, Lee FA, Earley C, Goldberg A, McPherson CA, Batsford WP, Soufer R. Effects of psychologic stress on repolarization and relationship to autonomic and hemodynamic factors. Journal Of Cardiovascular Electrophysiology 2005, 16: 372-7. PMID: 15828878, DOI: 10.1046/j.1540-8167.2005.40580.x.
  • Mental stress ischemia: present status and future goals.Burg MM, Vashist A, Soufer R. Mental stress ischemia: present status and future goals. Journal Of Nuclear Cardiology : Official Publication Of The American Society Of Nuclear Cardiology 2005, 12: 523-9. PMID: 16171711, DOI: 10.1016/j.nuclcard.2005.06.085.
  • Neurocardiac interaction during stress-induced myocardial ischemia: how does the brain cope?Soufer R. Neurocardiac interaction during stress-induced myocardial ischemia: how does the brain cope? Circulation 2004, 110: 1710-3. PMID: 15451806, DOI: 10.1161/01.CIR.0000144841.84987.50.
  • Simultaneous assessment of myocardial perfusion and function during mental stress in patients with chronic coronary artery disease.Arrighi JA, Burg M, Cohen IS, Soufer R. Simultaneous assessment of myocardial perfusion and function during mental stress in patients with chronic coronary artery disease. Journal Of Nuclear Cardiology : Official Publication Of The American Society Of Nuclear Cardiology 2003, 10: 267-74. PMID: 12794625, DOI: 10.1016/s1071-3581(02)43235-7.
  • MRI and PET study of deficits in hippocampal structure and function in women with childhood sexual abuse and posttraumatic stress disorder.Bremner JD, Vythilingam M, Vermetten E, Southwick SM, McGlashan T, Nazeer A, Khan S, Vaccarino LV, Soufer R, Garg PK, Ng CK, Staib LH, Duncan JS, Charney DS. MRI and PET study of deficits in hippocampal structure and function in women with childhood sexual abuse and posttraumatic stress disorder. The American Journal Of Psychiatry 2003, 160: 924-32. PMID: 12727697, DOI: 10.1176/appi.ajp.160.5.924.
  • Depressive symptoms and mortality two years after coronary artery bypass graft surgery (CABG) in men.Burg MM, Benedetto MC, Soufer R. Depressive symptoms and mortality two years after coronary artery bypass graft surgery (CABG) in men. Psychosomatic Medicine 2003, 65: 508-10. PMID: 12883097, DOI: 10.1097/01.psy.0000077509.39465.79.
  • Neural correlates of declarative memory for emotionally valenced words in women with posttraumatic stress disorder related to early childhood sexual abuse.Bremner JD, Vythilingam M, Vermetten E, Southwick SM, McGlashan T, Staib LH, Soufer R, Charney DS. Neural correlates of declarative memory for emotionally valenced words in women with posttraumatic stress disorder related to early childhood sexual abuse. Biological Psychiatry 2003, 53: 879-89. PMID: 12742675, DOI: 10.1016/s0006-3223(02)01891-7.
  • Presurgical depression predicts medical morbidity 6 months after coronary artery bypass graft surgery.Burg MM, Benedetto MC, Rosenberg R, Soufer R. Presurgical depression predicts medical morbidity 6 months after coronary artery bypass graft surgery. Psychosomatic Medicine 2003, 65: 111-8. PMID: 12554822, DOI: 10.1097/01.psy.0000038940.33335.09.
  • Brain, behavior, mental stress, and the neurocardiac interaction.Soufer R, Arrighi JA, Burg MM. Brain, behavior, mental stress, and the neurocardiac interaction. Journal Of Nuclear Cardiology : Official Publication Of The American Society Of Nuclear Cardiology 2002, 9: 650-62. PMID: 12466790, DOI: 10.1067/mnc.2002.129884.
  • Correlation of myocardial p-(123)I-iodophenylpentadecanoic acid retention with (18)F-FDG accumulation during experimental low-flow ischemia.Shi CQ, Young LH, Daher E, DiBella EV, Liu YH, Heller EN, Zoghbi S, Wackers FJ, Soufer R, Sinusas AJ. Correlation of myocardial p-(123)I-iodophenylpentadecanoic acid retention with (18)F-FDG accumulation during experimental low-flow ischemia. Journal Of Nuclear Medicine : Official Publication, Society Of Nuclear Medicine 2002, 43: 421-31. PMID: 11884504.
  • Reproducibility of in vivo brain measures of 5-HT2A receptors with PET and.Soares JC, van Dyck CH, Tan P, Zoghbi SS, Garg P, Soufer R, Baldwin RM, Fujita M, Staley JK, Fu X, Amici L, Seibyl J, Innis RB. Reproducibility of in vivo brain measures of 5-HT2A receptors with PET and. Psychiatry Research 2001, 106: 81-93. PMID: 11306248, DOI: 10.1016/s0925-4927(01)00071-3.
  • Comparison of [(18)F]altanserin and [(18)F]deuteroaltanserin for PET imaging of serotonin(2A) receptors in baboon brain: pharmacological studies.Staley JK, Van Dyck CH, Tan PZ, Al Tikriti M, Ramsby Q, Klump H, Ng C, Garg P, Soufer R, Baldwin RM, Innis RB. Comparison of [(18)F]altanserin and [(18)F]deuteroaltanserin for PET imaging of serotonin(2A) receptors in baboon brain: pharmacological studies. Nuclear Medicine And Biology 2001, 28: 271-9. PMID: 11323237, DOI: 10.1016/s0969-8051(00)00212-2.
  • Persistent changes in myocardial glucose metabolism in vivo during reperfusion of a limited-duration coronary occlusion.McNulty PH, Jagasia D, Cline GW, Ng CK, Whiting JM, Garg P, Shulman GI, Soufer R. Persistent changes in myocardial glucose metabolism in vivo during reperfusion of a limited-duration coronary occlusion. Circulation 2000, 101: 917-22. PMID: 10694532.
  • Myocardial blood-flow response during mental stress in patients with coronary artery disease.Arrighi JA, Burg M, Cohen IS, Kao AH, Pfau S, Caulin-Glaser T, Zaret BL, Soufer R. Myocardial blood-flow response during mental stress in patients with coronary artery disease. Lancet 2000, 356: 310-1. PMID: 11071190, DOI: 10.1016/S0140-6736(00)02510-1.
  • PET quantification of 5-HT2A receptors in the human brain: a constant infusion paradigm with [18F]altanserin.van Dyck CH, Tan PZ, Baldwin RM, Amici LA, Garg PK, Ng CK, Soufer R, Charney DS, Innis RB. PET quantification of 5-HT2A receptors in the human brain: a constant infusion paradigm with [18F]altanserin. Journal Of Nuclear Medicine : Official Publication, Society Of Nuclear Medicine 2000, 41: 234-41. PMID: 10688105.
  • Development and Reliability of a Method for Using Magnetic Resonance Imaging for the Definition of Regions of Interest for Positron Emission Tomography.Bremner JD, Bronen RA, De Erasquin G, Vermetten E, Staib LH, Ng CK, Soufer R, Charney DS, Innis RB. Development and Reliability of a Method for Using Magnetic Resonance Imaging for the Definition of Regions of Interest for Positron Emission Tomography. Clinical Positron Imaging : Official Journal Of The Institute For Clinical P.E.T 1998, 1: 145-159. PMID: 14516589, DOI: 10.1016/s1095-0397(98)00015-6.
  • Cerebral cortical hyperactivation in response to mental stress in patients with coronary artery disease.Soufer R, Bremner JD, Arrighi JA, Cohen I, Zaret BL, Burg MM, Goldman-Rakic P. Cerebral cortical hyperactivation in response to mental stress in patients with coronary artery disease. Proceedings Of The National Academy Of Sciences Of The United States Of America 1998, 95: 6454-9. PMID: 9600987, PMCID: PMC27794, DOI: 10.1073/pnas.95.11.6454.
  • Positron emission tomography measurement of cerebral metabolic correlates of yohimbine administration in combat-related posttraumatic stress disorder.Bremner JD, Innis RB, Ng CK, Staib LH, Salomon RM, Bronen RA, Duncan J, Southwick SM, Krystal JH, Rich D, Zubal G, Dey H, Soufer R, Charney DS. Positron emission tomography measurement of cerebral metabolic correlates of yohimbine administration in combat-related posttraumatic stress disorder. Archives Of General Psychiatry 1997, 54: 246-54. PMID: 9075465.
  • Positron emission tomography measurement of cerebral metabolic correlates of tryptophan depletion-induced depressive relapse.Bremner JD, Innis RB, Salomon RM, Staib LH, Ng CK, Miller HL, Bronen RA, Krystal JH, Duncan J, Rich D, Price LH, Malison R, Dey H, Soufer R, Charney DS. Positron emission tomography measurement of cerebral metabolic correlates of tryptophan depletion-induced depressive relapse. Archives Of General Psychiatry 1997, 54: 364-74. PMID: 9107153.
  • Kinetic analysis of technetium-99m-labeled nitroimidazole (BMS-181321) as a tracer of myocardial hypoxia.Ng CK, Sinusas AJ, Zaret BL, Soufer R. Kinetic analysis of technetium-99m-labeled nitroimidazole (BMS-181321) as a tracer of myocardial hypoxia. Circulation 1995, 92: 1261-8. PMID: 7648674, DOI: 10.1161/01.cir.92.5.1261.
  • The effect of incremental positive end-expiratory pressure on right ventricular hemodynamics and ejection fraction.Biondi JW, Schulman DS, Soufer R, Matthay RA, Hines RL, Kay HR, Barash PG. The effect of incremental positive end-expiratory pressure on right ventricular hemodynamics and ejection fraction. Anesthesia And Analgesia 1988, 67: 144-51. PMID: 3277479.
  • Effects of Psychological Stress on Vascular Physiology: Beyond the Current Imaging Signal.Shah SM, Meadows JL, Burg MM, Pfau S, Soufer R. Effects of Psychological Stress on Vascular Physiology: Beyond the Current Imaging Signal. Current Cardiology Reports 2020, 22: 156. PMID: 33037500, DOI: 10.1007/s11886-020-01406-x.
  • The Foundational Role of Cardiovascular Imaging in the Characterization of Mental Stress-Induced Myocardial Ischemia in Patients with Coronary Artery Disease.Meadows JL, Shah S, Burg MM, Pfau S, Soufer R. The Foundational Role of Cardiovascular Imaging in the Characterization of Mental Stress-Induced Myocardial Ischemia in Patients with Coronary Artery Disease. Current Cardiology Reports 2020, 22: 162. PMID: 33037938, DOI: 10.1007/s11886-020-01407-w.
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