Psychological Correlates of Mental Stress-induced Ischemia in the Laboratory

Ketterer, Mark W.; Freedland, Kenneth E.; Krantz, David S.; Kaufmann, Peter; Forman, Sandra; Greene, Anthony F.; Raczynski, James M.; Knatterud, Genell L.; Light, Kathy; Carney, Robert M.; Stone, Peter H.; Becker, Lewis C.; Sheps, David S.

doi:10.1177/135910530000500112

Cited by 19 publications

(9 citation statements)

References 42 publications

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“…This may appear paradoxical to those who assume that ischemia is the principle or only cause of angina in the CAD patient, since even artificial, contrived, and brief anger-evoking situations are known to cause ischemia in about half of patients with documented CAD [58]. We interpret this as indicating that the psychological causes of ischemia and angina may be distinct.…”

Section: Discussionmentioning

confidence: 63%

Symptoms of Anxiety and Depression Are Correlates of Angina Pectoris by Recent History and an Ischemia-Positive Treadmill Test in Patients with Documented Coronary Artery Disease in the Pimi Study

Ketterer

Bekkouche

Goldberg

et al. 2011

Cardiovascular Psychiatry and Neurology

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Objective. We tested the association of specific psychological characteristics in patients having stable coronary disease with the reporting of anginal symptoms during daily activities, and positive exercise testing. Methods. One hundred and ninety-six patients with documented CAD enrolled in the Psychophysiological Investigations of Myocardial Ischemia (PIMI) Study completed an anginal history questionnaire and a battery of psychometric tests. They also underwent standardized exercise treadmill tests. Results. Patients with a recent history of angina were more likely to be female, and had higher Beck Depression (P = .002), State Anxiety (P = .001), Trait Anxiety (P = .03), Harm Avoidance (P = .04) and Muscle Tension (P = .004) scores than patients who had no recent history of angina. Along with several treadmill variables indicating more severe disease state and reduced exercise tolerance, patients who developed angina on a positive treadmill test also displayed higher scores on the Beck Depression Inventory (P = .003) and State Anxiety (P = .004) scales. Conclusions. Several psychological characteristics, and most notably anxiety and depression, are strong correlates of recent angina and angina in the presence of ischemia provoked by treadmill testing.

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Section: Discussionmentioning

confidence: 63%

Symptoms of Anxiety and Depression Are Correlates of Angina Pectoris by Recent History and an Ischemia-Positive Treadmill Test in Patients with Documented Coronary Artery Disease in the Pimi Study

Ketterer

Bekkouche

Goldberg

et al. 2011

Cardiovascular Psychiatry and Neurology

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“…A previous study of 180 patients with stable CHD and a positive exercise stress test 27 reported no association between anger expression and mental stress-induced ischemia assessed by radionuclide ventriculography and electrocardiography, but state and trait-anger were not measured. This study did find a relationship between anger/irritability ratings in response to the speech stressor and myocardial ischemia.…”

Section: Discussionmentioning

confidence: 82%

Association between anger and mental stress–induced myocardial ischemia

Pimple

Shah

Rooks

et al. 2015

American Heart Journal

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Background Mental stress-induced myocardial ischemia is associated with adverse prognosis in coronary artery disease patients. Anger is thought to be a trigger of acute coronary syndromes and is associated with increased cardiovascular risk; however, little direct evidence exists for a link between anger and myocardial ischemia. Methods [99mTc]sestamibi single-photon emission tomography was performed at rest, after mental stress (a social stressor with a speech task), and after exercise/pharmacological stress. Summed scores of perfusion abnormalities were obtained by observer-independent software. A summed difference score, the difference between stress and rest scores, was used to quantify myocardial ischemia under both stress conditions. The Spielberger's State-Trait Anger Expression Inventory was used to assess different anger dimensions. Results The mean age was 50 years, 50% were female and 60% were non-white. After adjusting for demographic factors, smoking, coronary artery disease severity, depressive and anxiety symptoms, each interquartile range increment in state-anger score was associated with 0.36 units adjusted increase in ischemia as measured by the summed difference score (95% CI: 0.14-0.59); the corresponding association for trait-anger was 0.95 (95% CI: 0.21-1.69). Anger expression scales were not associated ischemia. None of the anger dimensions were related to ischemia during exercise/pharmacological stress. Conclusion Anger, both as an emotional state and as a personality trait, is significantly associated with propensity to develop myocardial ischemia during mental stress, but not during exercise/pharmacological stress. Patients with this psychological profile may be at increased risk for silent ischemia induced by emotional stress and this may translate into worse prognosis.

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“…Similarly, Boyle et al [31] found a significant association between the BDI-II score and inducible ischemia with mental stress; these authors also found that somatic depressive symptoms were better predictors of mental stress-induced ischemia than cognitive symptoms. On the other hand, Ketterer et al [11] and Burg et al [32] did not detect a significant association between depression and mental stress-induced myocardial ischemia in patients with CAD. These discrepancies may be due to variations in study populations and research protocols.…”

Section: Discussionmentioning

confidence: 92%

“…Ischemia induced by psychological stress is a common phenomenon in stable CAD patients [9] and is associated with a doubling of risk of cardiac events and death [10]. This phenomenon can be studied experimentally in the laboratory by using a standardized mental stress test [11], but it has rarely been evaluated with respect to depression.…”

Section: Introductionmentioning

confidence: 99%

Depressive Symptoms Are Associated with Mental Stress-Induced Myocardial Ischemia after Acute Myocardial Infarction

et al. 2014

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ObjectivesDepression is an adverse prognostic factor after an acute myocardial infarction (MI), and an increased propensity toward emotionally-driven myocardial ischemia may play a role. We aimed to examine the association between depressive symptoms and mental stress-induced myocardial ischemia in young survivors of an MI.MethodsWe studied 98 patients (49 women and 49 men) age 38–60 years who were hospitalized for acute MI in the previous 6 months. Patients underwent myocardial perfusion imaging at rest, after mental stress (speech task), and after exercise or pharmacological stress. A summed difference score (SDS), obtained with observer-independent software, was used to quantify myocardial ischemia under both stress conditions. The Beck Depression Inventory-II (BDI-II) was used to measure depressive symptoms, which were analyzed as overall score, and as separate somatic and cognitive depressive symptom scores.ResultsThere was a significant positive association between depressive symptoms and SDS with mental stress, denoting more ischemia. After adjustment for demographic and lifestyle factors, disease severity and medications, each incremental depressive symptom was associated with 0.14 points higher SDS. When somatic and cognitive depressive symptoms were examined separately, both somatic [β = 0.17, 95% CI: (0.04, 0.30), p = 0.01] and cognitive symptoms [β = 0.31, 95% CI: (0.07, 0.56), p = 0.01] were significantly associated with mental stress-induced ischemia. Depressive symptoms were not associated with ischemia induced by exercise or pharmacological stress.ConclusionAmong young post-MI patients, higher levels of both cognitive and somatic depressive symptoms are associated with a higher propensity to develop myocardial ischemia with mental stress, but not with physical (exercise or pharmacological) stress.

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Psychological Correlates of Mental Stress-induced Ischemia in the Laboratory

Cited by 19 publications

References 42 publications

Symptoms of Anxiety and Depression Are Correlates of Angina Pectoris by Recent History and an Ischemia-Positive Treadmill Test in Patients with Documented Coronary Artery Disease in the Pimi Study

Symptoms of Anxiety and Depression Are Correlates of Angina Pectoris by Recent History and an Ischemia-Positive Treadmill Test in Patients with Documented Coronary Artery Disease in the Pimi Study

Association between anger and mental stress–induced myocardial ischemia

Depressive Symptoms Are Associated with Mental Stress-Induced Myocardial Ischemia after Acute Myocardial Infarction

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