Usefulness of Peripheral Arterial Tonometry in the Detection of Mental Stress‐Induced Myocardial Ischemia

Hassan, Mustafa; York, Kaki M.; Li, Haihong; Li, Qin; Lucey, Dorian G.; Fillingim, Roger B.; Sheps, David S.

doi:10.1002/clc.20515

Cited by 34 publications

(33 citation statements)

References 29 publications

(18 reference statements)

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“…One possibility is that mental stress causes both coronary artery vasoconstriction and increased heart rate and/or blood pressure, thereby resulting in myocardial oxygen supply-demand mismatch. 15,18 This is supported by evidence linking mental stress to impaired endothelial function, 19 exaggerated peripheral microvascular tone, 3,16 and vasoconstriction of normal coronary artery segments. 20 These vasomotor effects likely occur through the activation of stress-response systems; indeed, plasma catecholamines increase rapidly with mental stress and correlate with hemodynamic changes.…”

Section: Discussionmentioning

confidence: 86%

“…Finally, most studies were based on cohorts enrolled decades ago, and none used myocardial perfusion imaging, which is believed to be more accurate for the detection of MSIMI than methods based on changes in left ventricular function. 15 Because mental stress increases peripheral vascular resistance, 3,16 changes in left ventricular function may reflect an increase in afterload rather than ischemia. 15 Despite these limitations and substantial differences in assessment protocols, it is remarkable that these studies yielded similar results.…”

Section: Discussionmentioning

confidence: 99%

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Meta-Analysis of Mental Stress–Induced Myocardial Ischemia and Subsequent Cardiac Events in Patients With Coronary Artery Disease

Wei

Rooks

Ramadan

et al. 2014

The American Journal of Cardiology

138

113

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Mental stress—induced myocardial ischemia (MSIMI) has been associated with adverse prognosis in patients with coronary artery disease (CAD), but whether this is a uniform finding across different studies has not been described. We conducted a systematic review and meta-analysis of prospective studies examining the association between MSIMI and adverse outcome events in patients with stable CAD. We searched PubMed, EMBASE, Web of Science, and PsycINFO databases for English language prospective studies of patients with CAD who underwent standardized mental stress testing to determine presence of MSIMI and were followed up for subsequent cardiac events or total mortality. Our outcomes of interest were CAD recurrence, CAD mortality, or total mortality. A summary effect estimate was derived using a fixed-effects meta-analysis model. Only 5 studies, each with a sample size of <200 patients and fewer than 50 outcome events, met the inclusion criteria. The pooled samples comprised 555 patients with CAD (85% male) and 117 events with a range of follow-up from 35 days to 8.8 years. Pooled analysis showed that MSIMI was associated with a twofold increased risk of a combined end point of cardiac events or total mortality (relative risk 2.24, 95% confidence interval 1.59 to 3.15). No heterogeneity was detected among the studies (Q = 0.39, I2 = 0.0%, p = 0.98). In conclusion, although few selected studies have examined the association between MSIMI and adverse events in patients with CAD, all existing investigations point to approximately a doubling of risk. Whether this increased risk is generalizable to the CAD population at large and varies in patient subgroups warrant further investigation.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Meta-Analysis of Mental Stress–Induced Myocardial Ischemia and Subsequent Cardiac Events in Patients With Coronary Artery Disease

Wei

Rooks

Ramadan

et al. 2014

The American Journal of Cardiology

138

113

View full text Add to dashboard Cite

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“…MSIMI is associated with peripheral vasoconstriction, 54, 62–66 which can be measured as a change in digital arterial pulse volume using digital tonometry. 18, 67, 68 Since changes in peripheral vascular tone may reflect changes in coronary vascular resistance, peripheral microvascular vasomotor response to mental stress may serve as a surrogate for similar changes in the coronary vasculature. 69 …”

Section: Discussionmentioning

confidence: 99%

The Mental Stress Ischemia Prognosis Study: Objectives, Study Design, and Prevalence of Inducible Ischemia

et al. 2017

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Objective Mental stress-induced myocardial ischemia (MSIMI) is a common phenomenon in patients with coronary artery disease (CAD), but contemporary studies of its prognostic significance and its underlying pathophysiology are limited. Methods We prospectively enrolled patients with confirmed CAD in the Mental Stress Ischemia Prognosis Study (MIPS) between 2011 and 2014. All patients underwent mental stress testing using a standardized public speaking task and ischemia was detected by 99mTc sestamibi myocardial perfusion imaging. Patients also underwent conventional stress testing for myocardial ischemia (CSMI) using exercise or pharmacological stress testing. Furthermore, digital microvascular flow, endothelial function, arterial stiffness and blood sample collections were performed before, during and after mental stress. Two-year adverse clinical outcomes are being assessed. Results Six-hundred and ninety-five patients completed baseline enrollment in the MIPS. Their mean (SD) age was 62.9 (9.1) years, 72% were men, 30% were African American, and 32% had a history myocardial infarction. The prevalence of MSIMI and CSIMI are 16.1% and 34.7%, respectively. A total of 151 (22.9%) patients had only CSIMI, 28 (4.2%) had only MSIMI and 78 (11.8%) had both MSIMI and CISIMI. Patients with ischemia had a lower ejection fraction and higher prevalence of previous coronary artery bypass grafting compared to those without inducible ischemia (p<0.050). The prevalence of obstructive CAD was not statistically different between patients with and without MSIMI (p=0.426); in contrast, it was higher in patients with CSIMI (p<0.001). Conclusion The MIPS data will provide useful information to assess the prognostic significance and underlying mechanisms of MSIMI.

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“…(13,26) Analyzable data free of artifact were available in 548 (81%) patients. Briefly, the device, which uses a modified form of plethysmography was applied to the index finger.…”

Section: Methodsmentioning

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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Usefulness of Peripheral Arterial Tonometry in the Detection of Mental Stress‐Induced Myocardial Ischemia

Abstract: We identified a pattern of peripheral arterial response to mental stress that has a relatively modest accuracy in predicting MSIMI. Further research is needed to validate the findings of this study.

Cited by 34 publications

References 29 publications

Meta-Analysis of Mental Stress–Induced Myocardial Ischemia and Subsequent Cardiac Events in Patients With Coronary Artery Disease

Meta-Analysis of Mental Stress–Induced Myocardial Ischemia and Subsequent Cardiac Events in Patients With Coronary Artery Disease

The Mental Stress Ischemia Prognosis Study: Objectives, Study Design, and Prevalence of Inducible Ischemia

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

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