Stress-Induced Autonomic Dysfunction is Associated With Mental Stress-Induced Myocardial Ischemia in Patients With
Jeffery Osei1, Viola Vaccarino1,2, Maggie Wang2
1Department of Epidemiology (J.O., V.V., A.S.S., L.Y.L., B.D.P., P.R., Y.V.S., L.C., A.J.S.), Rollins School of Public Health, Emory University, Atlanta, GA.
Insights
Mental stress can cause myocardial ischemia in coronary artery disease patients. Low heart rate variability (HRV) during stress, indicating autonomic dysfunction, is linked to increased odds of this ischemia.
Area of Science:
- Cardiology
- Autonomic Nervous System Research
- Clinical Investigation
Background:
- Mental stress-induced myocardial ischemia (MSIMI) is linked to poor cardiovascular outcomes in coronary artery disease (CAD) patients.
- The underlying mechanisms of MSIMI remain unclear.
- Autonomic dysfunction, indicated by low heart rate variability (HRV), is a potential factor.
Purpose of the Study:
- To investigate the association between stress-induced autonomic dysfunction and MSIMI in patients with stable CAD.
- To determine if low HRV during mental stress predicts MSIMI.
Main Methods:
- 735 patients with stable CAD underwent Holter monitoring during a speech stressor.
- Heart rate variability (HRV) was measured at rest and during stress.
- Autonomic dysfunction was defined as low HRV (first quartile) during stress; multivariable logistic regression analyzed its association with MSIMI.
Main Results:
- Low HRV during stress (both high and low frequencies) was significantly associated with higher odds of MSIMI (OR 2.1 for both).
- This association persisted after adjusting for demographic and clinical factors.
- Low HRV at rest also showed an association with MSIMI, though with a slightly reduced effect.
Conclusions:
- Mental stress-induced autonomic dysfunction may be a key mechanism in the development of MSIMI in CAD patients.
- Low HRV during stress is a predictor of MSIMI.
- Further research into autonomic dysfunction's role in MSIMI is warranted.
Background:
Mental stress-induced myocardial ischemia (MSIMI) is associated with adverse cardiovascular outcomes in individuals with coronary artery disease, but the mechanisms underlying this phenomenon are unknown. We examined the relationship between stress-induced autonomic dysfunction, measured by low heart rate variability (HRV) in response to stress, and MSIMI in patients with stable coronary artery disease. We hypothesized that stress-induced autonomic dysfunction is associated with higher odds of MSIMI.
Methods:
In 735 participants with stable coronary artery disease, we measured high- and low-frequency HRV in 5-minute intervals before and during a standardized laboratory-based speech stressor using Holter monitoring. HRV at rest and stress were categorized into low HRV (first quartile) versus high HRV (second to fourth quartiles); the low category was used as an indicator of autonomic dysfunction. Multivariable logistic regression models were used to examine the association of autonomic dysfunction with MSIMI.
Results:
The mean age was 58 (SD, ±10) years, 35% were women, 44% were Black participants, and 16% developed MSIMI. Compared with high HRV during stress, low HRV during stress (both high and low frequencies) was associated with higher odds of MSIMI after adjusting for demographic and clinical factors (odds ratio for high-frequency HRV, 2.1 [95% CI, 1.3-3.3]; odds ratio for low-frequency HRV, 2.1 [95% CI, 1.3-3.3]). Low-frequency HRV at rest was also associated with MSIMI but with slightly reduced effect estimates.
Conclusions:
In individuals with coronary artery disease, mental stress-induced autonomic dysfunction may be a mechanism implicated in the causal pathway of MSIMI.
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