Potential predictors for mental stress-induced myocardial ischemia in patients with coronary artery disease
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Published on: June 28, 2019
Mei-Yan Liu1, Ya Yang2, Li-Jun Zhang1
1Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
Insights
Higher levels of cardiac biomarkers and blood pressure predict mental stress-induced myocardial ischemia (MSIMI) in coronary artery disease (CAD) patients. These findings suggest hs-cTnI, NT-proBNP, and SBP could serve as valuable predictors for MSIMI risk.
Area of Science:
- Cardiology
- Biomarkers
- Clinical Prediction
Background:
- Mental stress-induced myocardial ischemia (MSIMI) is linked to adverse cardiac events in coronary artery disease (CAD) patients.
- Identifying predictors for MSIMI is crucial for risk stratification and management.
Purpose of the Study:
- To investigate whether specific biomarkers and blood pressure measurements can predict MSIMI in patients with CAD.
- To assess the association between resting and post-stressor levels of NT-proBNP, hs-cTnI, and SBP with the occurrence of MSIMI.
Main Methods:
- 82 patients with documented CAD were enrolled.
- Blood samples were collected at rest and after a mental arithmetic stress test.
- Statistical analyses included linear regression, ROC curves, and logistic regression.
Main Results:
- Patients with MSIMI showed significantly higher resting NT-proBNP and SBP compared to those without MSIMI.
- Post-stressor hs-cTnI and NT-proBNP levels were also significantly elevated in the MSIMI group.
- Logistic regression indicated that elevated post-stressor hs-cTnI (≥0.015 ng/mL), resting NT-proBNP (≥80.51 pg/mL), post-stressor NT-proBNP (≥98.80 pg/mL), and resting SBP (≥129.50 mmHg) were associated with a significantly increased risk of MSIMI.
Conclusions:
- Higher levels of hs-cTnI, NT-proBNP, and SBP are associated with an increased risk of MSIMI in CAD patients.
- These biomarkers and blood pressure measurements may serve as potential predictors for MSIMI.
Background:
Mental stress-induced myocardial ischemia (MSIMI) is closely associated with adverse cardiac events in patients with coronary artery disease (CAD) and we aimed to determine whether biomarkers and blood pressure could be potential predictors of MSIMI.
Methods:
This study enrolled 82 patients with documented CAD between June 1, 2017 and November 9, 2017. Patient blood samples were obtained at resting period and at the end of mental arithmetic. Then, patients were assigned to MSIMI positive group and MSIMI negative group. The main statistical methods included linear regression, receiver operating characteristic (ROC) curves, and logistic regression.
Results:
Patients with CAD with MSIMI had significantly greater median resting N-terminal pro-brain natriuretic peptide (NT-proBNP, 141.02 [45.85-202.76] pg/mL vs. 57.95 [27.06-117.64] pg/mL; Z = -2.23, P = 0.03) and mean systolic blood pressure (SBP) (145.56 ± 16.87 mmHg vs. 134.92 ± 18.16 mmHg, Z = -2.13, P = 0.04) when compared with those without MSIMI. After 5-min mental stress task, those who developed MSIMI presented higher elevation of median post-stressor high sensitivity cardiac troponin I (hs-cTnI, 0.020 [0.009-0.100] ng/mL vs. 0.009 [0.009-0.010] ng/mL; Z = -2.45, P = 0.01), post-stressor NT-proBNP (138.96 [39.93-201.56] pg/mL vs. 61.55 [25.66-86.50] pg/mL; Z = -2.15, P = 0.03) compared with those without MSIMI. Using the ROC curves, and after the adjustment for basic characteristics, the multiple logistic regression analysis showed that patients presenting a post-stressor hs-cTnI ≥ 0.015 ng/mL had seven-fold increase in the risk of developing MSIMI (odds ratio [OR]: 7.09; 95% confidence interval [CI]: 1.65-30.48; P = 0.009), a rest NT-proBNP ≥ 80.51 pg/mL had nearly eight-fold increase (OR: 7.85; 95% CI: 1.51-40.82; P = 0.014), a post-stressor NT-proBNP ≥ 98.80 pg/mL had 35-fold increase (OR: 34.96; 95% CI: 3.72-328.50; P = 0.002), a rest SBP ≥ 129.50 mmHg had 11-fold increase (OR: 11.42; 95% CI: 1.21-108.17; P = 0.034).
Conclusions:
The present study shows that CAD patients with higher hs-cTnI level, and/or greater NT-proBNP and/or SBP are at higher risk of suffering from MSIMI when compared with those without MSIMI, indicating that hs-cTnI, NT-proBNP, SBP might be potential predictors of MSIMI.
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