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Mental stress--induced myocardial ischemia and cardiac events
W Jiang1, M Babyak, D S Krantz
1Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
Insights
Mental stress-induced myocardial ischemia significantly increases cardiac event risk in coronary artery disease patients. This ischemia is an independent predictor of adverse events, suggesting psychological stress impacts heart health.
Area of Science:
- Cardiology
- Cardiovascular Research
- Clinical Medicine
Background:
- Coronary artery disease (CAD) affects millions globally.
- The role of psychological stress in cardiovascular events is increasingly recognized.
- Myocardial ischemia, a reduction in blood flow to the heart muscle, is a key indicator of cardiac events.
Purpose of the Study:
- To evaluate the clinical significance of myocardial ischemia induced by mental stress in patients diagnosed with coronary artery disease.
- To determine if mental stress-induced ischemia is an independent predictor of future cardiac events.
Main Methods:
- A cohort study involving 126 outpatients with documented CAD.
- Patients underwent baseline mental stress testing and exercise testing with radionuclide ventriculography and Holter monitoring.
- Cardiac events were tracked for up to 5 years via questionnaires and telephone follow-ups.
Main Results:
- Mental stress-induced ischemia was linked to a 2.8-fold increased risk of cardiac events.
- Left ventricular ejection fraction (LVEF) changes during mental stress predicted event-free survival, independent of baseline LVEF and prior myocardial infarction.
- This association remained significant even after accounting for exercise-induced ischemia.
Conclusions:
- Mental stress-induced myocardial ischemia is a significant predictor of fatal and nonfatal cardiac events in CAD patients.
- The findings suggest that psychological stress may adversely affect cardiac health through the mechanism of myocardial ischemia.
- These results highlight the importance of assessing mental stress responses in cardiovascular risk stratification.
Objective:
To assess the clinical significance of mental stress-induced myocardial ischemia in patients with coronary artery disease (CAD).
Design And Setting:
Cohort study in outpatients in a tertiary care teaching hospital assessed at baseline and followed up for up to 5 years.
Subjects:
A total of 126 volunteer patients (112 men, 14 women; mean age, 59 years) with documented CAD and exercise-induced myocardial ischemia.
Outcome Measures:
Patients underwent baseline mental stress and exercise testing using radionuclide ventriculography and 48-hour Holter monitoring. Patients were subsequently contacted by mailed questionnaires or telephone to document cardiac events, including death, nonfatal myocardial infarction, and cardiac revascularization procedures. Logistic regression and Cox proportional hazards models were used to examine the prognostic value of the ischemic measures after adjusting for such potential confounding factors as age, baseline left ventricular ejection fraction (LVEF), and history of myocardial infarction.
Results:
Twenty-eight patients (22%) experienced at least 1 cardiac event. Baseline mental stress-induced ischemia was associated with significantly higher rates of subsequent cardiac events (odds ratio, 2.8; 95% confidence interval [CI], 1.0-7.7; P < .05). The LVEF change during mental stress was significantly related to event-free survival (risk ratio [RR], 2.4; 95% CI, 1.12-5.14; P = .02), controlling for age, history of prior myocardial infarction, and baseline LVEF. This relationship remained significant after controlling for electrocardiogram (ECG)-defined ischemia during exercise (RR, 2.2; 95% CI, 1.01-4.81; P < .05). The RR for ECG-defined ischemia during exercise testing was 1.9 (95% CI, 0.95-3.96; P = .07) and the RR for ambulatory ECG ischemia was 0.75 (95% CI, 0.35-1.64; P = .47).
Conclusions:
The presence of mental stress-induced ischemia is associated with significantly higher rates of subsequent fatal and nonfatal cardiac events, independent of age, baseline LVEF, and previous myocardial infarction, and predicted events over and above exercise-induced ischemia. These data suggest that the relationship between psychological stress and adverse cardiac events may be mediated by the occurrence of myocardial ischemia.