Myocardial blood-flow response during mental stress in patients with coronary artery disease

Arrighi, James A.; Burg, Matthew M.; Cohen, Ira S.; Kao, Alexander H; Pfau, Steven; Caulin–Glaser, Teresa; Zaret, Barry L.; Soufer, Robert

doi:10.1016/s0140-6736(00)02510-1

Cited by 109 publications

(81 citation statements)

References 5 publications

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“…Moderate to extreme anger and associated emotions can provoke transient (18,19) and catastrophic ischemic syndromes (24,25), mediated in part by dysregulated vasomotor tone (25)(26)(27)). In the current study with CAD patients, AR stress, as expected, provoked an increase in sympathetic and a decrease in parasympathetic activity, however, only the latter predicted an associated increase in ET-1.…”

Section: Discussionmentioning

confidence: 99%

“…With this paradigm, the response to cognitive and emotional stressors has been characterized by heightened sympathetic nervous system activity, indexed by an increase in circulating levels of catecholamines (21), and reduced parasympathetic activity, indexed by reduced heart rate variability in the high frequency domain (22,23). Each of these effects contributes to elevations in heart rate, and systolic and diastolic blood pressure (24), and in patients with coronary artery disease (CAD), to reduced myocardial blood flow due to both epicardial vasoconstriction (25,26) and microvascular dysfunction (27). Laboratory emotional stress also provokes endothelial dysfunction that can persist for more than 90 min (29).…”

Section: Introductionmentioning

confidence: 99%

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Autonomic Contribution to Endothelin-1 Increase during Laboratory Anger-Recall Stress in Patients with Coronary Artery Disease

Burg

Soufer

Lampert

et al. 2011

Mol Med

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In coronary artery disease (CAD), endothelin-1 (ET-1) is released by activated macrophages and thereby contributes to coronary plaque rupture and triggered cardiac events. The multifactorial regulation of ET-1 includes stimulated release by cytokines and autonomic factors. Laboratory stress provokes alteration in autonomic tone and prolonged ET-1 mediated endothelial dysfunction. The objective of the study is to determine the autonomic contribution to an increase in ET-1 in response to laboratory stress in patients with CAD. Patients (n = 88) with chronic stable CAD instrumented with hemodynamic monitor, digital electrocardiogram (ECG) monitor and indwelling catheter for blood sampling completed a laboratory protocol that included initial rest (30 min), baseline (BL: 10 min), and anger recall stress (AR: 8 min). Change from BL to AR was determined for (a) parasympathetic activity (by spectral analysis of ECG); (b) sympathetic activity (by circulating catecholamines); and (c) ET-1. AR provoked increases from BL in catecholamines, and a decrease in parasympathetic activity. Multivariate analysis with change in parasympathetic activity and catecholamines, while controlling for age and use of β-blockers, revealed a significant odds ratio (OR = 3.27, 95% CI 1.03, 10.41 P = 0.04) for an increase in ET-1 associated with parasympathetic withdrawal; no other variables were significant. The predominant influence of parasympathetic activity on anger/stress-provoked increase in ET-1 is consistent with the cholinergic antiinflammatory pathway. Future examination of autonomic influences on atherosclerotic leukocytes, endothelial cell function and the dynamics of ET-1 are warranted.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Autonomic Contribution to Endothelin-1 Increase during Laboratory Anger-Recall Stress in Patients with Coronary Artery Disease

Burg

Soufer

Lampert

et al. 2011

Mol Med

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“…26 Myocardial ischemia elicited by mental stress testing has been shown to be associated not only with epicardial coronary artery abnormalities, but also with dysfunction of the coronary microcirculation. 27 …”

Section: Discussionmentioning

confidence: 99%

Peripheral arterial tonometry: A diagnostic method for detection of myocardial ischemia induced during mental stress tests: A pilot study

Goor

Sheffy

Schnall

et al. 2004

Clinical Cardiology

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Background: Mental stress testing is considered a reliable method for diagnosing patients with coronary heart disease (CHD) who may be at risk for future events. It has been shown recently that myocardial ischemia induced during mental stress tests is speciFICAlly associated with peripheral arterial vasoconstriction.Hypothesis: The study was undertaken to test the diagnostic capability of peripheral arterial tonometry (PAT) to detect peripheral arterial vasomotor changes.Methods: We monitored pulsatile finger blood volume changes using a specially designed finger plethysmograph, PAT that can detect peripheral arterial vasomotor changes. Equilibrium radionuclide angiography (ERNA) was simultaneously performed in 18 male patients at rest and during a mental arithmetic stress test with harassment. All patients had previously diagnosed coronary disease and positive exercise tests. Myocardial ischemia was diagnosed by ERNA when global ejection fraction fell ≥ 8% during mental stress or new (or worsened) focal wall motion abnormalities occurred. Peripheral arterial tonometry tracings were considered abnormal when the pulse wave amplitude decreased by ≥ 20% from baseline.Results: In 18 patients there were 16 usable studies. In eight patients, both ERNA and PAT were abnormal, and in six patients the tests were negative by both methods. In two cases, the results were discordant. Therefore, when considering an abnormal PAT tracing as indicative of mental stress‐driven myocardial ischemia, concordance of the two methods was 88%.Conclusion: The use of PAT may facilitate both clinical testing and research during mental stress.

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“…Everson, Goldberg, Kaplan, Julkunen, & Salonen, 1998;Porter, Stone & Schwartz, 1999;Arrighi et al, 2000). It has been presented either as a marker of pathogenic processes in atherosclerosis or as playing a role in its development (Krantz & Manuck, 1984).…”

Section: Cardiovascular Reactivity and Coronary Artery Diseasementioning

confidence: 99%

Hostility and anger expression behavioral and cardiovascular responses to mental stress among cardiovascular disease patients

Tucker¹

2002

PsycEXTRA Dataset

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Myocardial blood-flow response during mental stress in patients with coronary artery disease

Cited by 109 publications

References 5 publications

Autonomic Contribution to Endothelin-1 Increase during Laboratory Anger-Recall Stress in Patients with Coronary Artery Disease

Autonomic Contribution to Endothelin-1 Increase during Laboratory Anger-Recall Stress in Patients with Coronary Artery Disease

Peripheral arterial tonometry: A diagnostic method for detection of myocardial ischemia induced during mental stress tests: A pilot study

Hostility and anger expression behavioral and cardiovascular responses to mental stress among cardiovascular disease patients

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