Related Experiment Video
Updated: Jul 13, 2025
Intracoronary Acetylcholine Provocation Testing for Assessment of Coronary Vasomotor Disorders
Published on: August 18, 2016
Hemodynamic Reactivity to Mental Stress in Patients With Coronary Artery Disease
Kasra Moazzami1,2, Brian Cheung1, Samaah Sullivan3
1Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
Insights
A blunted cardiovascular response to mental stress in coronary artery disease (CAD) patients is linked to adverse outcomes. This suggests mental stress reactivity testing may aid risk assessment in stable CAD.
Area of Science:
- Cardiology
- Cardiovascular Research
- Clinical Medicine
Background:
- The clinical significance of hemodynamic reactivity to mental stress in coronary artery disease (CAD) patients remains unclear.
- Understanding this association is crucial for risk stratification and management of stable CAD.
Purpose of the Study:
- To investigate the association between hemodynamic reactivity to mental stress and the risk of adverse cardiovascular events in patients with stable CAD.
- To determine if mental stress reactivity testing can improve risk prediction models for cardiovascular events.
Main Methods:
- A cohort study pooled data from two prospective studies (MIPS and MIMS2) of patients with stable CAD.
- Rate-pressure product (RPP) reactivity to mental stress was assessed, defined as the change in RPP from rest to peak stress.
- The primary outcome was a composite of cardiovascular death or nonfatal myocardial infarction, with a secondary endpoint including heart failure hospitalizations.
Main Results:
- A blunted RPP reactivity to mental stress was associated with an increased risk of adverse cardiovascular events in both MIPS and MIMS2 cohorts.
- For every standard deviation decrease in RPP reactivity, adjusted hazard ratios for primary and secondary endpoints increased significantly.
- Incorporating RPP reactivity into risk models improved discrimination for adverse events by 5% in the pooled sample.
Conclusions:
- Blunted cardiovascular reactivity to mental stress is associated with adverse outcomes in patients with stable CAD.
- These findings suggest that assessing hemodynamic reactivity to mental stress may have clinical utility in identifying high-risk individuals.
- Further research is warranted to evaluate the clinical utility of mental stress reactivity testing in this population.
Importance:
The clinical significance of hemodynamic reactivity to mental stress in the population with coronary artery disease (CAD) is unclear.
Objective:
To investigate the association between hemodynamic reactivity to mental stress and the risk of adverse cardiovascular events in patients with stable CAD.
Design, Setting, And Participants:
This cohort study included individuals with stable CAD from 2 prospective studies from a university-based hospital network: the Mental Stress Ischemia Prognosis Study (MIPS) and the Myocardial Infarction and Mental Stress Study 2 (MIMS2). Participants were enrolled between June 2011 and March 2016 and followed up for a median of 6.0 (IQR, 5.6-6.0) years in MIPS and 4.6 (IQR, 3.8-5.3) years in MIMS2. Data were analyzed from December 1, 2022, to February 15, 2023.
Exposures:
The rate-pressure product (RPP) was calculated as the mean systolic blood pressure times the mean heart rate at rest. Rate-pressure product reactivity was calculated as the maximum RPP during a standardized mental stress test minus the RPP at rest.
Main Outcomes And Measures:
The primary outcome was a composite of cardiovascular death or nonfatal myocardial infarction. The secondary end point additionally included hospitalizations for heart failure.
Results:
From the total of 938 individuals from the pooled cohort (mean [SD] age, 60.2 [10.1] years; 611 [65.1%] men), 631 participated in MIPS and 307 in MIMS2. A total of 373 individuals (39.8%) were Black, 519 (55.3%) were White, and 46 (4.9%) were of unknown race or ethnicity. The RPP increased by a mean (SD) of 77.1% (23.1%) during mental stress (mean [SD] absolute change, 5651 [2878]). For every SD decrease in RPP reactivity with mental stress, the adjusted hazard ratios for the primary and secondary end points were 1.30 (95% CI, 1.04-1.72) and 1.30 (95% CI, 1.06-1.56), respectively, in MIPS and 1.41 (95% CI, 1.06-1.97) and 1.21 (95% CI, 1.02-1.60), respectively, in MIMS2. In the pooled sample, when RPP reactivity to mental stress was added to a model including traditional clinical risk characteristics, model discrimination for adverse events improved (increase in C statistic of 5% for the primary end point; P = .009).
Conclusions And Relevance:
In this cohort study of individuals with stable CAD, a blunted cardiovascular reactivity to mental stress was associated with adverse outcomes. Future studies are needed to assess the clinical utility of mental stress reactivity testing in this population.
Related Concept Videos
01:27Psychoneuroimmunology: Cardiovascular Disease
A key area of focus in PNI is the relationship between stress and coronary...
01:26Exercise Stress Test
Exercise stress testing, commonly known as a treadmill test, is a noninvasive procedure used to evaluate cardiovascular function and diagnose heart conditions.
Definition
An exercise stress test measures the heart's response to exertion using a treadmill or stationary bicycle. Chest electrodes record the heart's electrical activity through an ECG, and blood pressure is monitored regularly.
Purposes
01:18Neural Regulation of Blood Pressure
Baroreceptor Reflex
Baroreceptors, located in the carotid sinuses and aortic arch, detect changes in blood pressure. When blood pressure rises, these stretch-sensitive receptors...
01:31Regulation of Heart Rates
The SNS increases heart rate through the release of norepinephrine and epinephrine, which act on beta-1 adrenergic receptors in the heart. This action increases the rate of depolarization in the sinoatrial (SA) node, the heart's...
01:30Factors Influencing Heart Rate
Let us explore the significant factors affecting heart rate, including age, body temperature, posture, acute pain, chemical influences,...
01:29Pathophysiology of Cardiac Performance