Left Ventricular, Peripheral Vascular, and Neurohumoral Responses to Mental Stress in Normal Middle-Aged Men and Women

Becker, Lewis C.; Pepine, Carl J.; Bonsall, Robert W.; Cohen, Jerome D.; Goldberg, A.David; Coghlan, Cecil; Stone, Peter H.; Forman, Sandra; Knatterud, Genell L.; Sheps, David S.; Kaufmann, Peter

doi:10.1161/01.cir.94.11.2768

Cited by 131 publications

(67 citation statements)

References 27 publications

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“…Another mental stress-associated arrhythmogenic factor may be sympatho-adrenergic activation, which has been demonstrated in the laboratory setting by measuring increase of norepinephrine levels during mental stress. 31,32 Physical Stress, Sexual Activity, and Tachyarrhythmias…”

Section: Mental Stress and Tachyarrhythmiasmentioning

confidence: 99%

Triggering effect of physical and mental stress on spontaneous ventricular tachyarrhythmias in patients with implantable cardioverter‐defibrillators

Fries

König

Schäfers

et al. 2002

Clinical Cardiology

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SummaryBackground: Physical and mental stress as well as sexual activity are potential triggering factors of acute coronary events and sudden cardiac death.Hypothesis: These factors may also trigger recurrence of spontaneous ventricular tachyarrhythmias in patients with implantable cardioverter-defibrillators (ICDs).Methods: We performed a case-crossover study in 43 consecutive patients with 95 symptomatic, ICD-documented tachyarrhythmic events and calculated the relative risk of tachyarrhythmia recurrence during physical and mental stress. Physical and mental activity was graded on a 4-step intensity scale, and stress was defined as physical exertion or mental stress with an intensity grade ≥ II during or up to 1 h before arrhythmia recurrence. Relative risk was determined taking into account the habitual weekly stress frequency of each patient.Results: Physical stress was present in 26% (n = 25), mental stress in 24% (n = 23), and sexual activity in 2% (n = 2) of analyzed events. The weekly habitual stress frequency was 8 ± 8 (median 7) for physical stress, 6 ± 6 (median 4) for mental stress, and 0.5 ± 0.5 (median 0.25) for sexual activity. Thus, relative risk of arrhythmia recurrence during the presence of stress was 7.5 for physical activity (95% confidence interval [CI] 5.2-11.1), 9.5 (CI 6.3-14.5) for mental activity, and 7.5 (CI 2.3-24.8) for sexual activity.Conclusions: Physical and mental stress as well as sexual activity are factors that significantly increase relative risk of spontaneous recurrence of sustained ventricular tachyarrhyth-

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Section: Mental Stress and Tachyarrhythmiasmentioning

confidence: 99%

Triggering effect of physical and mental stress on spontaneous ventricular tachyarrhythmias in patients with implantable cardioverter‐defibrillators

Fries

König

Schäfers

et al. 2002

Clinical Cardiology

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“…We and others had also shown that decreased ejection fraction in response to mental stress in many cases does indicate ischemia, but that a substantial proportion of normals also have ejection fraction decreases, probably as a reflection of increased afterload rather than ischemia. 3,4 Because ejection fraction decrease does not appear to be a highly specific marker of ischemia in response to mental stress, it is not surprising that the PIMI data did not associate ejection fraction changes with increased mortality risk. Changes in blood pressure, heart rate, and catecholamines occur with mental stress, but do not differentiate people with myocardial ischemia from those without.…”

Section: Responsementioning

confidence: 99%

Mental Stress–Induced Ischemia and All-Cause Mortality in Patients With Coronary Artery Disease

2002

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Recently, an article in Circulation discussed the prognostic utility of mental stress-induced wall motion abnormalities. 1 The conclusion reached in the article is that the association between wall motion abnormalities during mental stress and mortality is important and probably underestimated by the unadjusted risk ratio of 2.79 (1.00 to 7.85). The authors suggest that investigations should be undertaken to determine whether a cheaper version of this test could be developed for the clinical setting.Before drawing such conclusions, alternative explanations of the findings need exploration. There were 17 deaths in this study. Wall motion abnormalities during the speech test were observed among 37 patients. A total of 6 patients were observed to have wall motion abnormalities during the speech test and then die within the follow-up period. Because the results of the paper were based on so few events, controlling for multiple potential confounders simultaneously was not possible but was probably desirable.Moreover, wall motion abnormalities during the speech test did not appear to have been chosen a priori to represent mental stress-induced ischemia. During both the Stroop and speech stress tests, several measures of mental stress-induced ischemia were evaluated, including ST-segment depression and reduced ejection fraction, as well as wall motion abnormalities. Indeed, numerous other measures of response to mental stress, such as blood pressure, heart rate, and catecholamine response, were reported, and these were not associated with mortality. Only wall motion abnormalities during the speech test were found to be associated with mortality. Multiple comparisons could account for the marginally significant result for wall motion abnormalities, and the lack of consistency across stress response measures does not inspire confidence in the reported association.The possibility of a relationship between mental stress and cardiovascular morality is an intriguing one. This article represents a thought-provoking exploratory analysis, and yet its conclusions are strong and unqualified. I would like to propose an alternate explanation for the results presented by the authors, one that was not given due consideration: chance. Gina ResponseDr Shellenbaum and colleagues suggest that our finding 1 of a relationship between mental stress-induced ischemia and subsequent cardiovascular mortality may be spurious. They point to the relatively small number of deaths and a "lack of consistency" between different mental stress variables and future mortality.In fact, the Psychophysiological Investigations of Myocardial Ischemia (PIMI) study was a carefully designed multicenter study with several prespecified a priori hypotheses. Radionuclide measures of myocardial ischemia (wall motion abnormality and change in ejection fraction) were prespecified as the most important variables to be analyzed as indicative of myocardial ischemia. 2 Our baseline studies in this population demonstrated that wall motion abnormality provoked by a public sp...

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“…The subject's task was to designate the color in which each word is presented as quickly as possible. This program was implemented in the Psychophysiological Investigations of Myocardial Ischemia Study (PIMI; Becker et al, 1996;Goldberg et al, 1996).…”

Section: Stroop Color-word Taskmentioning

confidence: 99%

Hostility and anger expression behavioral and cardiovascular responses to mental stress among cardiovascular disease patients

Tucker¹

2002

PsycEXTRA Dataset

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Left Ventricular, Peripheral Vascular, and Neurohumoral Responses to Mental Stress in Normal Middle-Aged Men and Women

Cited by 131 publications

References 27 publications

Triggering effect of physical and mental stress on spontaneous ventricular tachyarrhythmias in patients with implantable cardioverter‐defibrillators

Triggering effect of physical and mental stress on spontaneous ventricular tachyarrhythmias in patients with implantable cardioverter‐defibrillators

Mental Stress–Induced Ischemia and All-Cause Mortality in Patients With Coronary Artery Disease

Hostility and anger expression behavioral and cardiovascular responses to mental stress among cardiovascular disease patients

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