Noninvasive Detection of Risk for Emotion Provoked Myocardial Ischemia

Burg, Matthew M.; Graeber, Brendon; Vashist, Aseem; Collins, Dorothea; Earley, Christine; Liu, Joyce F.; Lampert, Rachel; Soufer, Robert

doi:10.1097/psy.0b013e318187c035

Cited by 39 publications

(31 citation statements)

References 30 publications

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“…In previous research 15 , the peripheral vascular response to emotional stress was better able to predict a myocardial perfusion defect during this stress among patients taking vs not taking angiotensin converting enzyme (ACE) inhibitors, with 90% accuracy in predicting the patients who did not demonstrate this flow defect. Following upon this finding, Ramadan et al 16 examined whether ACE inhibition “protected” patients from a myocardial perfusion defect during mental stress.…”

Section: Recent Findingsmentioning

confidence: 97%

“…Psychological factors were also a focus of the REMIT Trial, including depression, which has repeatedly been strongly linked to recurrent-ACS and mortality risk 14–15 . Boyle et al 13 reported that in REMIT, depression assessed by the Beck Depression Inventory (BDI) version II - but not the Centers for Disease Control Depression Scale - was marginally associated with probability of MSI, after adjustments for age, sex, resting LVEF, and resting wall motion (p = .053).…”

Section: Recent Findingsmentioning

confidence: 99%

“…This device measures beat-to-beat pulse wave amplitude (PWA) and generates a ratio of PWA during stress and rest that has previously been correlated with coronary vascular performance 21 . A lower ratio corresponds to vasoconstriction and predicts a myocardial perfusion defect during mental stress 15 . In pooled analysis of data from 384 patients, the extent and severity of coronary stenosis correlated significantly with myocardial perfusion defect at rest and during exercise stress (all p=0.001), as expected.…”

Section: Recent Findingsmentioning

confidence: 99%

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Psychological Stress and Induced Ischemic Syndromes

Burg

Soufer

2014

Curr Cardiovasc Risk Rep

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Section: Recent Findingsmentioning

confidence: 97%

Section: Recent Findingsmentioning

confidence: 99%

Section: Recent Findingsmentioning

confidence: 99%

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Psychological Stress and Induced Ischemic Syndromes

Burg

Soufer

2014

Curr Cardiovasc Risk Rep

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“…Laboratory studies have demonstrated that mental stress-induced myocardial ischemia occurs via several unique mechanisms, with the most consistently reported one seeming to be a widespread peripheral systemic vasoconstriction with consequent rapid rise in systemic vascular resistance and myocardial supply-demand related ischemia (6). In this issue of the journal, Burg and colleagues (7) demonstrate that this peripheral vasoconstrictive response to psychological stress provides a unique opportunity for the detection of mental stress ischemia. They report the utility of a novel peripheral arterial tonometry (PAT) technique for the detection of mental stress ischemia.…”

mentioning

confidence: 97%

A Noninvasive Clinically Useful Predictor for Mental Stress-Induced Ischemia

Hassan

Quyyumi

Sheps

2009

Psychosomatic Medicine

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“…Peripheral tonometric approaches have been developed for assessment of endothelial function and vascular health, and thresholds have been identified that provide acceptable sensitivity and specificity for myocardial ischemia. 31 The utilization of these technologies could be considered for the high risk, depressed, and diabetic patient group. Additional data to be included in risk stratification for the depressed patient with diabetes prior to MPI with mental stress could include thresholds of inflammation, ET-1, and body mass index, each of which has been implicated in the ischemia provoked under these conditions.…”

Section: Moving Forwardmentioning

confidence: 99%

The interface of emotion and biology in myocardial ischemia: Can we progress using the traditional paradigm?

Soufer

Burg

2017

Journal of Nuclear Cardiology

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Programmatic research conducted over the past 30 years has consistently found depression to be common in patients with coronary heart disease (CHD), yet it is often unrecognized. Furthermore, depression in this group has been shown to increase risk for recurrent cardiac events and mortality. The threshold of depression severity at which risk is conferred can be quite low and substantially below the threshold associated with a diagnosis of major depression, and the pathway(s) by which depression confers risk may involve physiologic and/or behavioral factors. A higher than expected prevalence of depression is also characteristic of the patient group with diabetes, and similarly is associated with an elevated risk of medical complications and early mortality. Here too, the pathways linking depression to outcomes in this patient group appear to involve both physiologic and behavioral factors.The current article by Haaf et al. 1 adds to this literature by focusing specifically on incident CHD riskevidenced by a new myocardial perfusion defect-in diabetic patients with depression. In a sub-study of the BARDOT trial, patients with type 2 diabetes and free from coronary disease manifestations or symptoms at baseline underwent assessment that included myocardial perfusion imaging (MPI) with SPECT and either exercise or pharmacologic stress, along with assessment of psychosocial functioning, including depression. These assessments were repeated 2 years later, and the predictors of new onset MPI defect were tested. Of many variables-including both biologic and psychologic-it was only the psychological measures-depression in particular-that predicted new onset MPI defect. While the sample was not large for a population study, and the number of new 'events' small-in part due perhaps to the length of follow-up-the findings of this paper nonetheless raise important questions regarding risk assessment and surveillance in this high-risk patient group. DEPRESSION AND CHDSeveral large, prospective epidemiological studies of initially healthy individuals have shown that a history of major depression disorder (MDD) carries up to a fourfold elevated risk of incident CHD, 2 with metaanalyses 3 showing depression to carry a relative risk of 1.64 for incident CHD, independent of standard risk factors and markers including poor diet, tobacco use, and lack of physical activity. In patients with CHD, defined as chronic, stable coronary disease, unstable angina, or a history of prior acute coronary syndrome (ACS) event, up to 40% evidence clinically meaningful depression symptomatology, and overall, 15% to 20% meet criteria for MDD, 4 a rate three times greater than in the general population.5 Hospitalized ACS patients with depression during hospital admission are highly likely to have had depression prior to their cardiac event, 6 which should not be surprising, as depression is a recurring, remitting disorder. DEPRESSION AND DIABETESOverall, the comorbidity of depression and CHD mirrors that of depression and diabetes. Approximately 25% o...

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Noninvasive Detection of Risk for Emotion Provoked Myocardial Ischemia

Cited by 39 publications

References 30 publications

Psychological Stress and Induced Ischemic Syndromes

Psychological Stress and Induced Ischemic Syndromes

A Noninvasive Clinically Useful Predictor for Mental Stress-Induced Ischemia

The interface of emotion and biology in myocardial ischemia: Can we progress using the traditional paradigm?

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