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Brain Correlates of Mental Stress-Induced Myocardial Ischemia
J Douglas Bremner1, Carolina Campanella, Zehra Khan
1From the Departments of Psychiatry and Behavioral Sciences (Bremner, Campanella, Khan, M. Shah), Radiology (Bremner, Garcia, Nye), and Medicine (Cardiology), Emory University School of Medicine (Hammadah, Wilmot, Al Mheid, Lima, A. Shah, Quyyumi, Vaccarino), Atlanta, Georgia; Department of Epidemiology (Ward, Pearce, A. Shah, Vaccarino) and Biostatistics (Kutner), Rollins School of Public Health, Emory University, Atlanta, GA; Atlanta VA Medical Center (Bremner, A. Shah), Decatur, Georgia; and the Mazankowski Alberta Heart Institute; and Department of Medicine (Raggi), University of Alberta, Edmonton, Alberta, Canada.
Insights
Mental stress triggers brain activity linked to myocardial ischemia in coronary artery disease (CAD) patients. This brain reactivity may explain how stress increases CAD risk and related mortality.
Area of Science:
- Cardiology
- Neuroscience
- Psychology
Background:
- Coronary artery disease (CAD) remains a leading cause of death, with mechanisms still under investigation.
- Behavioral factors, particularly emotional stress, are increasingly recognized for their role in CAD risk.
- Brain regions associated with memory and stress responses influence the cardiovascular system.
Purpose of the Study:
- To evaluate the impact of mental stress on brain and cardiac function in patients with CAD.
- To investigate the neural correlates of mental stress-induced myocardial ischemia.
Main Methods:
- 170 CAD patients underwent cardiac imaging (SPECT) at rest and during mental stress (public speaking).
- Brain imaging (PET) was performed during mental stress (arithmetic, public speaking) and control conditions.
- Analysis focused on brain activation patterns in response to different stressors.
Main Results:
- Mental stress-induced myocardial ischemia correlated with increased activation in the anterior cingulate, inferior frontal gyrus, and parietal cortex.
- Both arithmetic and public speaking stress elicited significant brain activation.
- Specific stress types were associated with activation in distinct brain regions like the insula and temporal gyrus.
Conclusions:
- Mental stress-induced myocardial ischemia is linked to heightened activity in brain areas regulating stress and autonomic cardiovascular control.
- Altered brain responses to stress may represent a key mechanism contributing to CAD morbidity and mortality.
- This research highlights the critical interplay between psychological stress and cardiovascular health in CAD patients.
Objective:
Coronary artery disease (CAD) is a major cause of morbidity and mortality, and despite important advances in our understanding of this disorder, the underlying mechanisms remain under investigation. Recently, increased attention has been placed on the role of behavioral factors such as emotional stress on CAD risk. Brain areas involved in memory and the stress response, including medial prefrontal cortex, insula, and parietal cortex, also have outputs to the peripheral cardiovascular system. The purpose of this study was to assess the effects of mental stress on brain and cardiac function in patients with CAD.
Methods:
CAD patients (N = 170) underwent cardiac imaging with [Tc-99m] sestamibi single-photon emission tomography at rest and during a public speaking mental stress task. On another day, they underwent imaging of the brain with [O-15] water positron emission tomography (PET) during mental stress (arithmetic and public speaking) and control conditions.
Results:
Patients with mental stress-induced myocardial ischemia showed increased activation with stress in anterior cingulate, inferior frontal gyrus, and parietal cortex (p < .005). This was seen with both arithmetic stress and public speaking stress. Arithmetic stress was additionally associated with left insula activation, and public speaking with right pre/postcentral gyrus and middle temporal gyrus activation (p < .005).
Conclusions:
These findings suggest that mental stress-induced myocardial ischemia is associated with activation in brain areas involved in the stress response and autonomic regulation of the cardiovascular system. Altered brain reactivity to stress could possibly represent a mechanism through which stress leads to increased risk of CAD-related morbidity and mortality.
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