Mental stress-induced myocardial ischaemia

Arri, Satpal; Ryan, M. J.; Redwood, Simon; Marber, Michael

doi:10.1136/heartjnl-2014-307306

Cited by 49 publications

(50 citation statements)

References 79 publications

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“…Increased myocardial oxygen demand in a setting of decreased myocardial perfusion are two key determinants of myocardial ischemia. (38) However, the relationship between the hemodynamic response to mental stress and the risk of MSIMI has remained controversial to date. While some studies, including our preliminary report of 225 patients of this cohort,(13) showed no association,(39–43) others are consistent with our findings.…”

Section: Discussionmentioning

confidence: 99%

“…(12,44) Whereas mental stress is associated with peripheral and coronary vasoconstriction and an increase in peripheral vascular resistance,(40,41) exercise stress in largely accompanied by peripheral vasodilatation. (12,38,44) The increase in peripheral vascular resistance during mental stress results in a significant increase in left ventricular afterload, strain, and myocardial wall tension that further compromises endocardial perfusion. (38) These factors may explain why MSIMI occurs at lower workloads in comparison to exercise stress-induced myocardial ischemia.…”

Section: Discussionmentioning

confidence: 99%

“…(12,38,44) The increase in peripheral vascular resistance during mental stress results in a significant increase in left ventricular afterload, strain, and myocardial wall tension that further compromises endocardial perfusion. (38) These factors may explain why MSIMI occurs at lower workloads in comparison to exercise stress-induced myocardial ischemia. (12) Furthermore, significant epicardial coronary arterial vasoconstriction has been observed in response to mental stress in coronary segments with underlying atherosclerosis.…”

Section: Discussionmentioning

confidence: 99%

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Hemodynamic, catecholamine, vasomotor and vascular responses: Determinants of myocardial ischemia during mental stress

Hammadah

Alkhoder

Mheid

et al. 2017

International Journal of Cardiology

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Aims Mental stress-induced myocardial ischemia (MSIMI) in patients with coronary artery disease (CAD) is associated with adverse cardiovascular outcomes. We aim to assess hemodynamic, neuro-hormonal, endothelial, vasomotor and vascular predictors of MSIMI. Methods and Results We subjected 660 patients with stable CAD to 99mTc sestamibi myocardial perfusion imaging at rest, with mental (speech task) and with conventional (exercise/pharmacological) stress. Endothelium-dependent flow-mediated dilation (FMD), microvascular reactivity [reactive hyperemia index (RHI)] and arterial stiffness [pulse wave velocity (PWV)] were measured at rest and 30-min after mental stress. The digital microvascular vasomotor response during mental stress was assessed using peripheral arterial tonometry (PAT). A total of 106(16.1%) patients had MSIMI. Mental stress was accompanied by significant increases in rate-pressure-product (heart rate x systolic blood pressure; RPP), epinephrine levels and PWV, and significant decreases in FMD and PAT ratio denoting microvascular constriction. In comparison to those with no MSIMI, patients with MSIMI had higher hemodynamic and digital vasoconstrictive responses (p<0.05 for both), but did not differ in epinephrine, endothelial or macrovascular responses. Only presence of ischemia during conventional stress (OR of 7.1, 95%CI of 4.2, 11.9), high hemodynamic response (OR for RPP response ≥ vs < ROC cutoff of 1.8, 95%CI of 1.1, 2.8), and high digital vasoconstriction (OR for PAT ratio < vs ≥ ROC cutoff of 2.1, 95%CI of 1.3, 3.3) were independent predictors of MSIMI. Conclusion Ischemia during conventional stress testing and hemodynamic and vasoconstrictive responses to mental stress can help predict subjects with CAD at greater risk of developing MSIMI.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Hemodynamic, catecholamine, vasomotor and vascular responses: Determinants of myocardial ischemia during mental stress

Hammadah

Alkhoder

Mheid

et al. 2017

International Journal of Cardiology

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“…These results suggest that men with MSIMI are effectively cardiac stress reactors, with increased myocardial oxygen demands, and women with MSIMI are more likely to be vascular reactors, with greater endothelial driven increases in vascular resistance (which leads to increased left ventricular afterload and dysfunction). 8 However, the article by Sullivan et al does only provide initial insights, and there is a great deal of further information that we need. For example, building a more complex map of MSIMI, to include additional measures of the autonomic nervous system, the hypothalamic-pituitary-adrenal axis, nitric oxide release and usage, coagulation, and, most importantly, microvascular function, along with a more balanced sample of men and women is needed to adequately disentangle sex differences in MSIMI.…”

Section: See Accompanying Article On Page 473mentioning

confidence: 99%

The Importance of Sex in the Stress–Heart Disease Relationship and the Potential Contribution of Gender to Future Research

Bacon

2018

ATVB

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We now have numerous studies that have linked increased levels of negative emotions and stress with the development and progression of cardiovascular disease-a relationship that seems to be sex specific in its pattern of outcomes. 1,2 However, the mechanisms of these relationships are still a source of much debate. One of the strongest potential pathways linking acute psychological stress with worse outcomes is through mental stress-induced myocardial ischemia (MSIMI).3 Though there is a large overlap (ca. 70%) in individuals who demonstrate both MSIMI and more common (ie, exercise or pharmacological) stress-induced ischemia, 4 these seem to be distinctly different entities. Firstly, it would seem that more individuals are likely to have MSIMI only than exercise/pharmacological stress-induced ischemia only (20% versus 10%).5 Furthermore, the profiles and potential mechanistic factors of those at risk for MSIMI compared with exercise/pharmacological stress-induced ischemia are different. For example, those individuals who exhibit MSIMI are more likely to be women, have greater microvascular disease, have poorer left ventricular dysfunction, and display endothelial dysfunction, whereas exercise/pharmacological stress-induced ischemia is generally associated with men and those with larger and more diffuse coronary artery plaque. [4][5][6] Though there are sex differences in the rates of presentations of both MSIMI and exercise/pharmacological stress-induced ischemia, both men and women do exhibit both of these forms of ischemia. However, we do not know if the mechanistic factors that underlie these stress-induced ischemia differ by sex; for example, does MSIMI in women differ from MSIMI in men? Understanding these processes can ultimately help in the development of better tailored diagnostic procedures and interventions to treat cardiovascular disease. See accompanying article on page 473The article by Sullivan et al 7 provides some important initial insights into sex differences in the potential mechanisms driving MSIMI. This secondary analysis of 678 (25% women) patients in the MIPS study (Mental Stress Ischemia Mechanisms and Prognosis) evaluated mental stress (public speaking)-induced vascular and hemodynamic responses. The authors found that MSIMI was generally driven by peripheral vasoconstriction in women compared with increased hemodynamic workload in men, results that were independent of exercise/pharmacological stress-induced ischemia. These results suggest that men with MSIMI are effectively cardiac stress reactors, with increased myocardial oxygen demands, and women with MSIMI are more likely to be vascular reactors, with greater endothelial driven increases in vascular resistance (which leads to increased left ventricular afterload and dysfunction).8 However, the article by Sullivan et al does only provide initial insights, and there is a great deal of further information that we need. For example, building a more complex map of MSIMI, to include additional measures of the autonomic nervous system, the...

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“…An increase in CVE cases may reduce the susceptible pool for stroke and vice versa. However things may be different at the molecular, cellular and physiological level [59][60] .…”

Section: -39mentioning

confidence: 99%

The Excitement Theory and Cardiovascular Events.

Reza¹

2017

IJAR

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Mental stress-induced myocardial ischaemia

Cited by 49 publications

References 79 publications

Hemodynamic, catecholamine, vasomotor and vascular responses: Determinants of myocardial ischemia during mental stress

Hemodynamic, catecholamine, vasomotor and vascular responses: Determinants of myocardial ischemia during mental stress

The Importance of Sex in the Stress–Heart Disease Relationship and the Potential Contribution of Gender to Future Research

The Excitement Theory and Cardiovascular Events.

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