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Hemodynamic, catecholamine, vasomotor and vascular responses: Determinants of myocardial ischemia during mental
Muhammad Hammadah1, Ayman Alkhoder1, Ibhar Al Mheid1
1Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States.
Insights
Mental stress can induce myocardial ischemia in coronary artery disease patients. Hemodynamic and digital vasoconstrictive responses to stress predict this ischemia, aiding risk assessment.
Area of Science:
- Cardiology
- Cardiovascular Physiology
- Stress Testing
Background:
- Mental stress-induced myocardial ischemia (MSIMI) is linked to poor outcomes in coronary artery disease (CAD) patients.
- Identifying predictors of MSIMI is crucial for risk stratification and management.
Purpose of the Study:
- To evaluate hemodynamic, neuro-hormonal, endothelial, vasomotor, and vascular predictors of MSIMI in patients with stable CAD.
Main Methods:
- 660 stable CAD patients underwent myocardial perfusion imaging during rest, mental stress, and conventional stress.
- Measurements included flow-mediated dilation (FMD), reactive hyperemia index (RHI), pulse wave velocity (PWV), and peripheral arterial tonometry (PAT).
Main Results:
- 16.1% of patients developed MSIMI.
- MSIMI patients showed higher hemodynamic and digital vasoconstrictive responses to mental stress.
- Independent predictors of MSIMI were ischemia during conventional stress, high hemodynamic response, and high digital vasoconstriction.
Conclusions:
- Conventional stress testing results, along with hemodynamic and vasoconstrictive responses to mental stress, are valuable in predicting MSIMI risk in CAD patients.
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
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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