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Cardiovascular and Circulatory Responses to Acute Mental Stress Among Individuals With Ischemic Cardiomyopathy
Kasra Moazzami1, Maggie Wang, Alireza Rahbar
1Department of Medicine, Division of Cardiology (Moazzami, Wang, Rahbar, Shah, Sun, Quyyumi); Department of Epidemiology, Rollins School of Public Health (Moazzami, Wang, Pearce, Shah, Sun, Vaccarino); Department of Biostatistics and Bioinformatics, Rollins School of Public Health (Ko); Department of Hematology and Oncology, Winship Cancer Institute (Bremner), Emory University School of Medicine, Atlanta, Georgia; Grady Health System, Atlanta, Georgia (Moazzami); Atlanta VA Healthcare System, Decatur, Georgia (Shah, Sun, Bremner); Department of Medicine, Division of Cardiology, University of Alberta, Edmonton, Canada (Raggi).
Insights
Individuals with heart failure with reduced ejection fraction (HFrEF) and coronary artery disease (CAD) show abnormal responses to mental stress. These include blunted blood pressure changes, increased vasoconstriction, inflammation, and progenitor cell mobilization, indicating poorer long-term outcomes.
Area of Science:
- Cardiology
- Immunology
- Physiology
Background:
- Stable coronary artery disease (CAD) affects millions worldwide.
- Heart failure with reduced ejection fraction (HFrEF) is a common complication of CAD.
- Understanding stress responses in CAD patients with and without HFrEF is crucial for risk stratification.
Purpose of the Study:
- To investigate the physiological and immunological responses to acute mental stress in individuals with stable CAD.
- To compare these responses between patients with and without heart failure with reduced ejection fraction (HFrEF).
Main Methods:
- A cohort of 313 individuals with stable CAD (45 with HFrEF) underwent laboratory-based mental stress testing.
- Hemodynamic reactivity (systolic blood pressure changes) and vasoconstriction (peripheral arterial tonometry) were assessed.
- Immune function was evaluated by measuring Interleukin-6 (IL-6) levels and circulating progenitor cell counts.
Main Results:
- Patients with HFrEF demonstrated a blunted systolic blood pressure increase (30.4 vs. 41.9 mm Hg) and greater vasoconstriction (PAT ratio 0.69 vs. 0.83) during stress.
- HFrEF patients exhibited significantly higher increases in IL-6 levels (0.91 vs. 0.42 pg/ml) and circulating progenitor cells (0.68 vs. 0.22 cell/L).
- These maladaptive stress responses remained independently associated with HFrEF after adjusting for risk factors.
Conclusions:
- The presence of HFrEF in patients with stable CAD is linked to distinct, adverse physiological and immune responses during mental stress.
- These include impaired blood pressure regulation, heightened vasoconstriction, increased inflammation, and enhanced progenitor cell mobilization.
- These stress-induced alterations in HFrEF patients are associated with poorer long-term health outcomes.
Objective:
We studied responses to acute mental stress in individuals with stable coronary artery disease (CAD) with and without heart failure with reduced ejection fraction (HFrEF).
Methods:
Individuals with stable CAD ( N = 313, 45 with HFrEF) underwent a laboratory-based mental stress. HFrEF was defined as an ejection fraction of <40%. Hemodynamic reactivity and vasoconstriction during mental stress were evaluated using changes in systolic blood pressure and peripheral arterial tonometry, respectively. Immune function was assessed by measuring changes in interleukin-6 (IL-6) and circulating progenitor cell counts enumerated using flow cytometry of CD34-expressing mononuclear cells before and 90 minutes after mental stress.
Results:
During the mental stress testing, patients in the HFrEF exhibited a smaller (blunted) increase in systolic blood pressure compared with the non HFrEF group (30.4 ± 14.1 vs 41.9 ± 16.1 mm Hg, p < .001), greater vasoconstriction (PAT ratio 0.69 ± 0.30 vs 0.83 ± 0.40, p = .02), a larger increase in IL-6 levels (0.91 ± 0.11 vs 0.42 ± 0.14 pg/mL, p = .01), and larger increases in circulating progenitor cell counts (0.68 ± 0.12 vs 0.22 ± 0.11 cell/L, p = .009). After adjustment for demographic and traditional risk factors, each of these 4 maladaptive stress responses remained independently associated with the presence of HFrEF.
Conclusions:
Among individuals with stable CAD, the presence of HFrEF was independently associated with a blunted systolic blood pressure response, greater vasoconstriction, increased inflammation, and enhanced progenitor cell mobilization with mental stress, a response that is associated with adverse long-term outcomes.
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