TY - JOUR
T1 - Mental stress-induced myocardial ischemia and cognitive impairment in coronary atherosclerosis
AU - Moazzami, Kasra
AU - Sullivan, Samaah
AU - Lima, Bruno B.
AU - Kim, Jeong Hwan
AU - Hammadah, Muhammad
AU - Almuwaqqat, Zakaria
AU - Shah, Amit J.
AU - Hajjar, Ihab
AU - Goldstein, Felicia C.
AU - Levey, Allan I.
AU - Bremner, J. Douglas
AU - Quyyumi, Arshed A.
AU - Vaccarino, Viola
N1 - Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2021/2
Y1 - 2021/2
N2 - Objective: To understand if presence of mental stress-induced myocardial ischemia (MSIMI) is associated with higher prevalence of cognitive impairment at baseline and its decline over time. Methods: A cohort of participants with stable coronary atherosclerosis underwent acute mental stress testing using a series of standardized speech/arithmetic stressors. The stress/rest digital vasomotor response to mental stress (sPAT) was assessed to measure microvascular constriction during mental stress. Patients received 99mTc-sestamibi myocardial perfusion imaging at rest, with mental stress and with conventional (exercise/pharmacological) stress. Cognitive function was assessed both at baseline and at a 2 year follow-up using the Trail Making Test parts A and B and the verbal and visual memory subtests of the Wechsler Memory Scale. Results: We studied 486 individuals (72% male, 32.1% Black, 62 ± 9 (mean ± SD) years old). After multivariable adjustment for baseline demographics, risk factors, and medication use, presence of MSIMI was associated with 21% and 20% slower completion of Trail-A and Trail-B, respectively (p for all <0.01). After a 2-year follow-up period, presence of MSIMI was associated with a 33% slower completion of Trail-B, denoting cognitive decline (B = 0.33, 95% CI, 0.04, 0.62). A lower sPAT, indicating greater vasoconstriction, mediated the association between MSIMI and worsening Trail-B performance by 18.2%. Ischemia with a conventional stress test was not associated with any of the cognitive tests over time. Conclusion: MSIMI is associated with slower visuomotor processing and worse executive function at baseline and with greater decline in these abilities over time.
AB - Objective: To understand if presence of mental stress-induced myocardial ischemia (MSIMI) is associated with higher prevalence of cognitive impairment at baseline and its decline over time. Methods: A cohort of participants with stable coronary atherosclerosis underwent acute mental stress testing using a series of standardized speech/arithmetic stressors. The stress/rest digital vasomotor response to mental stress (sPAT) was assessed to measure microvascular constriction during mental stress. Patients received 99mTc-sestamibi myocardial perfusion imaging at rest, with mental stress and with conventional (exercise/pharmacological) stress. Cognitive function was assessed both at baseline and at a 2 year follow-up using the Trail Making Test parts A and B and the verbal and visual memory subtests of the Wechsler Memory Scale. Results: We studied 486 individuals (72% male, 32.1% Black, 62 ± 9 (mean ± SD) years old). After multivariable adjustment for baseline demographics, risk factors, and medication use, presence of MSIMI was associated with 21% and 20% slower completion of Trail-A and Trail-B, respectively (p for all <0.01). After a 2-year follow-up period, presence of MSIMI was associated with a 33% slower completion of Trail-B, denoting cognitive decline (B = 0.33, 95% CI, 0.04, 0.62). A lower sPAT, indicating greater vasoconstriction, mediated the association between MSIMI and worsening Trail-B performance by 18.2%. Ischemia with a conventional stress test was not associated with any of the cognitive tests over time. Conclusion: MSIMI is associated with slower visuomotor processing and worse executive function at baseline and with greater decline in these abilities over time.
KW - Cognitive impairment
KW - Coronary artery disease
KW - Mental stress
KW - Vasoconstriction
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U2 - 10.1016/j.jpsychores.2020.110342
DO - 10.1016/j.jpsychores.2020.110342
M3 - Article
C2 - 33360843
AN - SCOPUS:85098142120
SN - 0022-3999
VL - 141
JO - Journal of Psychosomatic Research
JF - Journal of Psychosomatic Research
M1 - 110342
ER -