Psychological Stress and Induced Ischemic Syndromes

Burg, Matthew M.; Soufer, Robert

doi:10.1007/s12170-014-0377-6

Cited by 21 publications

(29 citation statements)

References 30 publications

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“…Only 1 stress task is feasible with [ 99m Tc]sestamibi SPECT perfusion imaging, and this could be seen as an additional limitation. However, multiple mental stress tasks with short resting periods in between may not be more informative than just 1 task, because of possible carryover effects from one condition to the next . The use of myocardial perfusion imaging is a strength of our study, because it remains the gold standard for ischemia assessment.…”

Section: Discussionmentioning

confidence: 99%

“…However, multiple mental stress tasks with short resting periods in between may not be more informative than just 1 task, because of possible carryover effects from one condition to the next. 49,50 The use of myocardial perfusion imaging is a strength of our study, because it remains the gold standard for ischemia assessment. Furthermore, a major advantage of this technique for mental stress testing is that the radioisotope, once injected during mental stress, is trapped in the myocyte, providing a "snapshot" of perfusion at the time of stress.…”

Section: Discussionmentioning

confidence: 99%

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Sex Differences in Mental Stress‐Induced Myocardial Ischemia in Patients With Coronary Heart Disease

Vaccarino

Wilmot

Mheid

et al. 2016

JAHA

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BackgroundEmerging data suggest that young women with coronary heart disease (CHD) are disproportionally vulnerable to the adverse cardiovascular effects of psychological stress. We hypothesized that younger, but not older, women with stable CHD are more likely than their male peers to develop mental stress‐induced myocardial ischemia (MSIMI).Methods and ResultsWe studied 686 patients (191 women) with stable coronary heart disease (CHD). Patients underwent 99mTc‐sestamibi myocardial perfusion imaging at rest and with both mental (speech task) and conventional (exercise/pharmacological) stress testing. We compared quantitative (by automated software) and visual parameters of inducible ischemia between women and men and assessed age as an effect modifier. Women had a more‐adverse psychosocial profile than men whereas there were few differences in medical history and CHD risk factors. Both quantitative and visual indicators of ischemia with mental stress were disproportionally larger in younger women. For each 10 years of decreasing age, the total reversibility severity score with mental stress was 9.6 incremental points higher (interaction, P<0.001) and the incidence of MSIMI was 82.6% higher (interaction, P=0.004) in women than in men. Incidence of MSIMI in women ≤50 years was almost 4‐fold higher than in men of similar age and older patients. These results persisted when adjusting for sociodemographic and medical risk factors, psychosocial factors, and medications. There were no significant sex differences in inducible ischemia with conventional stress.ConclusionsYoung women with stable CHD are susceptible to MSIMI, which could play a role in the prognosis of this group.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Sex Differences in Mental Stress‐Induced Myocardial Ischemia in Patients With Coronary Heart Disease

Vaccarino

Wilmot

Mheid

et al. 2016

JAHA

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“…The women in these studies were more likely to have psychosocial risk factors for cardiovascular disease, including lower income, minority race, history of emotional or sexual abuse in childhood, and higher number of depressive symptoms (Samad et al, 2014; Vaccarino et al, 2014; Xu et al, 2015). This psychosocial profile may result in increased physiological responsivity to acute stressors, which is particularly well captured using myocardial perfusion imaging during stress (Burg and Soufer, 2014). MSIMI in women does not appear to be related to a greater cardiovascular reactivity, however, as no differences were found blood pressure, heart rate and other hemodynamic parameters between women and men, with men even showing a tendency for higher responses with stress (Becker et al, 1996; Samad et al, 2014; Steptoe et al, 1996; Vaccarino et al, 2014; York et al, 2007).…”

Section: Emotional Factors and Coronary Heart Disease In Womenmentioning

confidence: 99%

Behavioral, emotional and neurobiological determinants of coronary heart disease risk in women

Vaccarino

Bremner

2017

Neuroscience & Biobehavioral Reviews

102

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Women have more of the stress-related behavioral profile that has been linked to cardiovascular disease than men. For example, women double the rates of stress-related mental disorders such as depression and posttraumatic stress disorder (PTSD) than men, and have higher rates of exposure to adversity early in life. This profile may increase women's long-term risk of cardiometabolic conditions linked to stress, especially coronary heart disease (CHD). In addition to having a higher prevalence of psychosocial stress-ors, women may be more vulnerable to the adverse effects of these stressors on CHD, perhaps through altered neurobiological physiology. Emerging data suggest that young women are disproportionally susceptible to the adverse effects of stress on the risk of cardiovascular disease, both in terms of initiating the disease as well as worsening the prognosis in women who have already exhibited symptoms of the disease. Women's potential vulnerability to psychosocial stress could also help explain their higher propensity toward abnormal coronary vasomotion and microvascular disease compared with men.

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“…(1,2) In the laboratory, mental stress provocation can precipitate myocardial ischemia that can be diagnosed as reversible left ventricular dysfunction, transient electrocardiographic abnormalities or perfusion defects during nuclear imaging. (1–3) In comparison to ischemia with conventional exercise or pharmacological stress testing, mental stress-induced myocardial ischemia (MSIMI) is usually silent, occurs at a lower workload than exercise-induced ischemia and is independent of the underlying burden of CAD.…”

Section: Introductionmentioning

confidence: 99%

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

Hammadah

Alkhoder

Mheid

et al. 2017

International Journal of Cardiology

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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.

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Psychological Stress and Induced Ischemic Syndromes

Cited by 21 publications

References 30 publications

Sex Differences in Mental Stress‐Induced Myocardial Ischemia in Patients With Coronary Heart Disease

Sex Differences in Mental Stress‐Induced Myocardial Ischemia in Patients With Coronary Heart Disease

Behavioral, emotional and neurobiological determinants of coronary heart disease risk in women

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

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