Mental stress-induced ischemia in patients with coronary artery disease: echocardiographic characteristics and relation to exercise-induced ischemia

• Published in: Psychosomatic medicine 2012-09, Vol.74 (7), p.766-772
• Main Authors: Stepanovic, Jelena, Ostojic, Miodrag, Beleslin, Branko, Vukovic, Olivera, Djordjevic-Dikic, Ana, Dikic, Ana Djordjevic, Giga, Vojislav, Nedeljkovic, Ivana, Nedeljkovic, Milan, Stojkovic, Sinisa, Vukcevic, Vladan, Dobric, Milan, Petrasinovic, Zorica, Marinkovic, Jelena, Lecic-Tosevski, Dusica
• Format: Article
• Language: English
• Subjects: Adult; Anger; Cardiovascular disease; Coronary Artery Disease - complications; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - physiopathology; Coronary diseases; Echocardiography; Echocardiography, Stress; Electrocardiography; Exercise; Exercise Test; Female; Humans; Ischemia; Male; Middle Aged; Myocardial Ischemia - diagnostic imaging; Myocardial Ischemia - etiology; Myocardial Ischemia - physiopathology; Parameters; Psychosomatic medicine; Recall; Stress; Stress, Psychological - complications; Stress, Psychological - diagnostic imaging; Stress, Psychological - physiopathology; Ultrasonic imaging
• ISSN: 0033-3174; 1534-7796
• DOI: 10.1097/PSY.0b013e3182689441

The aims of this study were to investigate the incidence and parameters associated with myocardial ischemia during mental stress (MS) as measured by echocardiography and to evaluate the relation between MS-induced and exercise-induced myocardial ischemia. Study participants were 79 patients (63 men; mean [M] [standard deviation {SD}] age = 52 [8] years) with angiographically confirmed coronary artery disease and previous positive exercise test result. The MS protocol consisted of mental arithmetic and anger recall task. The patients performed a treadmill exercise test 15 to 20 minutes after the MS task. Data of post-MS exercise were compared with previous exercise stress test results. The frequency of echocardiographic abnormalities was 35% in response to the mental arithmetic task, compared with 61% with anger recall and 96% with exercise (p < .001, exercise versus MS). Electrocardiogram abnormalities and chest pain were substantially less common during MS than were echocardiographic abnormalities. Independent predictors of MS-induced myocardial ischemia were: wall motion score index at rest (p = .02), peak systolic blood pressure (p = .005), and increase in rate-pressure product (p = .004) during MS. The duration of exercise stress test was significantly shorter (p < .001) when MS preceded the exercise and in the case of earlier exercise (M [SD] = 4.4 [1.9] versus 6.7 [2.2] minutes for patients positive on MS and 5.7 [1.9] versus 8.0 [2.3] minutes for patients negative on MS). Echocardiography can be successfully used to document myocardial ischemia induced by MS. MS-induced ischemia was associated with an increase in hemodynamic parameters during MS and worse function of the left ventricle. MS may shorten the duration of subsequent exercise stress testing and can potentiate exercise-induced ischemia in susceptible patients with coronary artery disease.