Mental Stress-Induced Myocardial Ischemia

Mehta, Puja K.; Sharma, Ashish; Bremner, J. Douglas; Vaccarino, Viola

doi:10.1007/s11886-022-01821-2

Cited by 16 publications

(10 citation statements)

References 106 publications

(159 reference statements)

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“…The increased thromboembolic risk in cancer patients is a complex and multifactorial phenomenon, including the release of several pro-coagulant factors by tumors [ 29 ]. Since ATE risk is higher in the early months after cancer diagnosis, psychological stress affecting cancer patients can represent a trigger for ATE events [ 37 ]. Thrombus formation is the final stage of complex interactions between coagulation, fibrinolysis, and innate immune systems.…”

Section: Discussionmentioning

confidence: 99%

The Conundrum of Cancer-Associated Thrombosis: Lesson Learned from Two Intriguing Cases and Literature Review

Laurino,

Russi,

Omer

et al. 2024

Diseases

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The correlation between cancer and venous thromboembolism (VTE) is solid, whereas the knowledge about cancer-related arterial thromboembolism (ATE) still needs a deeper investigation to clarify its pathogenesis. We describe two cases that represent useful hints for a comprehensive review of the thrombotic issue. A 75-year-old man with advanced rectal cancer treated with fluoropyrimidines suffered two catheter-related VTE events managed according to current guidelines. There was no indication for “extended” anticoagulant therapy for him, but during antithrombotic wash-out and fluoropyrimidines plus panitumumab regimen, he suffered a massive right coronary artery (RCA) thrombosis. Another patient with no cardiovascular (CV) risk factors and affected by advanced bladder cancer was treated with a platinum-containing regimen and suffered an acute inferior myocardial infarction 2 days after chemotherapy administration. He was successfully treated with primary Percutaneous Transluminal Coronary Angioplasty of RCA, discontinuing platinum-based therapy. Our observations raise the issue of cancer-associated thrombosis (CAT) complexity and the potential correlation between arterial and venous thrombotic events. Moreover, physicians should be aware of the thrombotic risk associated with anticancer therapies, suggesting that an appropriate prophylaxis should be considered.

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Section: Discussionmentioning

confidence: 99%

The Conundrum of Cancer-Associated Thrombosis: Lesson Learned from Two Intriguing Cases and Literature Review

Laurino,

Russi,

Omer

et al. 2024

Diseases

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“…Lastly, one possible explanation for the negative and opposite findings in the association between low HRV and CSIMI may be attributed to the fact that CSIMI is dependent on vasodilation and coronary steal, while MSIMI is more of a phenomenon related to vasoconstriction. 35 Individuals with low HRV and concomitant coronary endothelial dysfunction may experience less vasodilation from exercise or regadenoson pharmacological stress. This may, in turn, reduce the chances of CSIMI.…”

Section: Discussionmentioning

confidence: 99%

Stress-Induced Autonomic Dysfunction is Associated With Mental Stress–Induced Myocardial Ischemia in Patients With Coronary Artery Disease

Osei,

Vaccarino,

Wang

et al. 2024

Circ: Cardiovascular Imaging

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BACKGROUND: Mental stress–induced myocardial ischemia (MSIMI) is associated with adverse cardiovascular outcomes in individuals with coronary artery disease, but the mechanisms underlying this phenomenon are unknown. We examined the relationship between stress-induced autonomic dysfunction, measured by low heart rate variability (HRV) in response to stress, and MSIMI in patients with stable coronary artery disease. We hypothesized that stress-induced autonomic dysfunction is associated with higher odds of MSIMI. METHODS: In 735 participants with stable coronary artery disease, we measured high- and low-frequency HRV in 5-minute intervals before and during a standardized laboratory-based speech stressor using Holter monitoring. HRV at rest and stress were categorized into low HRV (first quartile) versus high HRV (second to fourth quartiles); the low category was used as an indicator of autonomic dysfunction. Multivariable logistic regression models were used to examine the association of autonomic dysfunction with MSIMI. RESULTS: The mean age was 58 (SD, ±10) years, 35% were women, 44% were Black participants, and 16% developed MSIMI. Compared with high HRV during stress, low HRV during stress (both high and low frequencies) was associated with higher odds of MSIMI after adjusting for demographic and clinical factors (odds ratio for high-frequency HRV, 2.1 [95% CI, 1.3–3.3]; odds ratio for low-frequency HRV, 2.1 [95% CI, 1.3–3.3]). Low-frequency HRV at rest was also associated with MSIMI but with slightly reduced effect estimates. CONCLUSIONS: In individuals with coronary artery disease, mental stress-induced autonomic dysfunction may be a mechanism implicated in the causal pathway of MSIMI.

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“…The ANS dysregulation induces several deleterious downstream changes, including stimulation of leukopoiesis from the bone marrow, direct induction of vasoconstriction, and stimulation of catecholamine release (Figure ). 13 Additionally, activation of the hypothalamicpituitary-adrenal axis results in the secretion of glucocorticoids from the adrenal cortex. Both pathways occur simultaneously, although with differences in response horizons.…”

Section: See Article By Osei Et Almentioning

confidence: 99%