TY - JOUR
T1 - Hemodynamic, catecholamine, vasomotor and vascular responses
T2 - Determinants of myocardial ischemia during mental stress
AU - Hammadah, Muhammad
AU - Alkhoder, Ayman
AU - Al Mheid, Ibhar
AU - Wilmot, Kobina
AU - Isakadze, Nino
AU - Abdulhadi, Naser
AU - Chou, Danielle
AU - Obideen, Malik
AU - O'Neal, Wesley T.
AU - Sullivan, Samaah
AU - Tahhan, Ayman Samman
AU - Kelli, Heval Mohamed
AU - Ramadan, Ronnie
AU - Pimple, Pratik
AU - Sandesara, Pratik
AU - Shah, Amit J.
AU - Ward, Laura
AU - Ko, Yi An
AU - Sun, Yan
AU - Uphoff, Irina
AU - Pearce, Brad
AU - Garcia, Ernest V.
AU - Kutner, Michael
AU - Bremner, J. Douglas
AU - Esteves, Fabio
AU - Sheps, David S.
AU - Raggi, Paolo
AU - Vaccarino, Viola
AU - Quyyumi, Arshed A.
N1 - Publisher Copyright:
© 2017 Elsevier B.V.
PY - 2017/9/15
Y1 - 2017/9/15
N2 - 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.
AB - 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.
KW - Arterial stiffness
KW - Catecholamines
KW - Conventional stress test
KW - Endothelial dysfunction
KW - Mental stress
KW - Myocardial ischemia
KW - Peripheral arterial tonometry
KW - Vasoconstriction
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U2 - 10.1016/j.ijcard.2017.05.093
DO - 10.1016/j.ijcard.2017.05.093
M3 - Article
C2 - 28571621
AN - SCOPUS:85019653826
SN - 0167-5273
VL - 243
SP - 47
EP - 53
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -