[Mental stress test in patients with stable coronary artery disease]

Myocardial ischemia may be triggered by exercise and non-exercise stimuli.

Of this study was to determine the usefulness of laboratory mental stress (MS) in inducing myocardial ischemia and/or cardiac arrhythmia in patients (pts) post myocardial infarction, with stable coronary artery disease. Sixty four men, mean age 45 +/- 6 years underwent: 15 min mental stress test during 24 h Holter monitoring and exercise stress testing.

Only 8 pts (13%) had positive mental stress test (MS+). Five of them had ST segment depression > 1.0 mm (STD), and the remaining 3 pts had cardiac arrhythmias. All episodes were silent. MS+ pts had higher heart rate (HR) during the mental test than those with negative stress test (MS-) (120/min vs 105/min, p < 0.05). In contrast, at least one episode of daily life ischemia (DLI) was recorded in 23 pts (36%) on Holter monitoring. In MS+ pts average duration of DLI (17 min) and mean HR during ischemia (124/min) were greater than in MS-pts (respectively 10.5 min and 94/min, p < 0.05). Exercise induced ischemia (STD > 1.0 mm) was observed in 29 of 64 pts (45%). However, in MS+ pts exercise duration (708 +/- 132 s), time to 1 mm STD (432 +/- 108 s) were significantly shorter and double product at 1 mm STD (13,400 +/- 2913 mm Hg/min) was lower than in MS- pts (respectively 924 +/- 174 s, p < 0.01; 624 +/- 162 s, p < 0.01; 14,800 +/- 3321 mmHg/min, p < 0.05).

Mental stress test is a weak inducer of ischemia and arrhythmia in patients with stable coronary artery disease. Patients with mental stress-induced ischemia are more likely to display ischemia during daily life and exercise stress testing.