The Mental Stress Ischemia Prognosis Study: Objectives, Study Design, and Prevalence of Inducible Ischemia
Muhammad Hammadah1, Ibhar Al Mheid, Kobina Wilmot
1From the Division of Cardiology (Hammadah, Al Mheid, Wilmot, Ramadan, Shah, Vaccarino, Quyyumi), Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; Department of Epidemiology (Shah, Sun, Pearce, Raggi, Vaccarino), Rollins School of Public Health, Emory University, Atlanta, Georgia; Atlanta VA Medical Center (Shah, Bremner), Decatur, Georgia; Department of Radiology (Garcia, Esteves, Raggi), Emory University School of Medicine, Atlanta, Georgia; Department of Biostatistics and Bioinformatics (Kutner), Rollins School of Public Health, Emory University, Atlanta, Georgia; Department of Psychiatry and Behavioral Sciences (Bremner), Emory University School of Medicine; Mazankowski Alberta Heart Institute (Raggi), University of Alberta, Edmonton, Alberta, Canada; and Division of Cardiovascular Medicine (Sheps), Department of Medicine, University of Florida Health Science Center, Jacksonville, Florida.
Insights
Mental stress-induced myocardial ischemia (MSIMI) is prevalent in coronary artery disease (CAD) patients. Further research is needed to understand its prognostic significance and mechanisms.
Area of Science:
- Cardiology
- Cardiovascular Research
- Clinical Medicine
Background:
- Mental stress-induced myocardial ischemia (MSIMI) is a recognized phenomenon in patients with coronary artery disease (CAD).
- Limited contemporary studies exist on the prognostic implications and underlying pathophysiology of MSIMI.
- Understanding MSIMI is crucial for managing CAD patients experiencing stress-related cardiac events.
Purpose of the Study:
- To prospectively investigate the prognostic significance of MSIMI in patients with confirmed CAD.
- To explore the underlying pathophysiological mechanisms of MSIMI.
- To compare MSIMI with conventional stress-induced myocardial ischemia (CSIMI).
Main Methods:
- Prospective enrollment of 695 patients with confirmed CAD in the Mental Stress Ischemia Prognosis Study (MIPS).
- Assessment of MSIMI using Tc-sestamibi myocardial perfusion imaging after a public speaking stress test.
- Evaluation of conventional stress-induced myocardial ischemia (CSIMI) via exercise or pharmacological testing, alongside microvascular function, endothelial function, and arterial stiffness measurements.
Main Results:
- The prevalence of MSIMI was 16.1% and CSIMI was 34.7%.
- Patients with ischemia (MSIMI or CSIMI) exhibited lower ejection fraction and higher rates of prior coronary artery bypass grafting.
- Obstructive CAD was not significantly different in patients with MSIMI but was higher in those with CSIMI.
Conclusions:
- The Mental Stress Ischemia Prognosis Study (MIPS) is gathering valuable data on MSIMI.
- This data will contribute to a better understanding of the prognostic significance of MSIMI.
- Further analysis of MIPS data will elucidate the mechanisms driving mental stress-induced myocardial ischemia.
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 Tc-sestamibi myocardial perfusion imaging. Patients also underwent conventional stress testing for myocardial ischemia (CSIMI) 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 ninety-five patients completed baseline enrollment in the MIPS. Their mean (standard deviation) 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 is 16.1% and 34.7%, respectively. A total of 151 patients (22.9%) had only CSIMI, 28 (4.2%) had only MSIMI, and 78 (11.8%) had both MSIMI and CSIMI. Patients with ischemia had a lower ejection fraction and higher prevalence of previous coronary artery bypass grafting compared with those without inducible ischemia (p < .050). The prevalence of obstructive CAD was not statistically different between patients with and without MSIMI (p = .426); in contrast, it was higher in patients with CSIMI (p < .001).
Conclusions:
The MIPS data will provide useful information to assess the prognostic significance and underlying mechanisms of MSIMI.
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