Hemodynamic, catecholamine, vasomotor and vascular responses: Determinants of myocardial ischemia during mental stress

Abstract

Aims Mental stress-induced myocardial ischemia (MSIMI) in patients with coronary artery disease (CAD) is associated with adverse cardiovascular outcomes. We aim to assess hemodynamic, neuro-hormonal, endothelial, vasomotor and vascular predictors of MSIMI. Methods and Results We subjected 660 patients with stable CAD to 99mTc sestamibi myocardial perfusion imaging at rest, with mental (speech task) and with conventional (exercise/pharmacological) stress. Endothelium-dependent flow-mediated dilation (FMD), microvascular reactivity [reactive hyperemia index (RHI)] and arterial stiffness [pulse wave velocity (PWV)] were measured at rest and 30-min after mental stress. The digital microvascular vasomotor response during mental stress was assessed using peripheral arterial tonometry (PAT). A total of 106(16.1%) patients had MSIMI. Mental stress was accompanied by significant increases in rate-pressure-product (heart rate x systolic blood pressure; RPP), epinephrine levels and PWV, and significant decreases in FMD and PAT ratio denoting microvascular constriction. In comparison to those with no MSIMI, patients with MSIMI had higher hemodynamic and digital vasoconstrictive responses (p<0.05 for both), but did not differ in epinephrine, endothelial or macrovascular responses. Only presence of ischemia during conventional stress (OR of 7.1, 95%CI of 4.2, 11.9), high hemodynamic response (OR for RPP response ≥ vs < ROC cutoff of 1.8, 95%CI of 1.1, 2.8), and high digital vasoconstriction (OR for PAT ratio < vs ≥ ROC cutoff of 2.1, 95%CI of 1.3, 3.3) were independent predictors of MSIMI. Conclusion Ischemia during conventional stress testing and hemodynamic and vasoconstrictive responses to mental stress can help predict subjects with CAD at greater risk of developing MSIMI.

Posttraumatic stress disorder is associated with enhanced interleukin-6 response to mental stress in subjects with a recent myocardial infarction

“…Blood pressure and heart rate were recorded throughout the test. This mental stress protocol has been validated and widely used in CHD patients (Goldberg et al, 1996; Kim et al, 2003; Ramachandruni et al, 2006; Sheps et al, 2002), and found to be highly reproducible and predictive of mental stress induced myocardial-ischemia and of hemodynamic and vascular responses to stress in our laboratory, as previously reported (Hammadah et al, 2017a; Sullivan et al, 2018). …”

miR-126 in Peripheral Blood Mononuclear Cells Negatively Correlates with Risk and Severity and is Associated with Inflammatory Cytokines as well as Intercellular Adhesion Molecule-1 in Patients with Coronary Artery Disease

“…As a leading cause of deaths and disabilities worldwide, CAD brings about a large economic burden and an enormous cost in manpower every year [2]. Age, hypertension, hyperlipidemia, and diabetic mellitus are classic risk factors, and other novel factors such as stress and periodontitis have also been highlighted [3,4,5,6]. Angiography is a gold standard for diagnosing CAD, while the invasive technique has limited its application in clinical practice, leading to the exploration of biomarkers that may have the potential of diagnosis and supervision of CAD.…”

Coronary and Peripheral Vasomotor Responses to Mental Stress

“…[1][2][3] Acute MS results in transient pathological hemodynamic and neuroendocrine activation. 4 Vasomotor changes in the coronary conductance and resistance vessels modulate coronary blood flow (CBF) during physiologic and psychological stress. 5,6 For example, vasodilation of the epicardial and coronary microvasculature during maximal exercise can increase CBF by 4-to 5-fold, with the greatest contribution coming from dilation of the resistance or microvessels.…”

“…Several studies have assessed peripheral vascular changes by measuring digital vasoconstriction in response to MS, by utilizing a noninvasive peripheral arterial tonometry (PAT) device. 4,13,14 The degree of peripheral microvascular constriction measured with this device has been related to the propensity toward MS-induced myocardial ischemia (MSIMI) in patients with CAD. 4,13,14 Whether there is any relationship between peripheral and coronary vasomotion during MS has not been previously studied and is a goal of our investigation.…”

“…4,13,14 The degree of peripheral microvascular constriction measured with this device has been related to the propensity toward MS-induced myocardial ischemia (MSIMI) in patients with CAD. 4,13,14 Whether there is any relationship between peripheral and coronary vasomotion during MS has not been previously studied and is a goal of our investigation. 4 In this study we aimed to examine the relationship between coronary vascular responses to MS and (1) endothelium-dependent epicardial (coronary diameter response) and microvascular function (acetylcholine-mediated CBF and resistance responses), (2) endothelium-independent epicardial and microvascular function (sodium nitroprusside-mediated responses), and (3) endothelium-independent coronary flow reserve (response to adenosine), in patients with stable CAD.…”