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

• Published in: International journal of cardiology 2017-09, Vol.243, p.47-53
• Main Authors: Hammadah, Muhammad, Alkhoder, Ayman, Al Mheid, Ibhar, Wilmot, Kobina, Isakadze, Nino, Abdulhadi, Naser, Chou, Danielle, Obideen, Malik, O'Neal, Wesley T, Sullivan, Samaah, Tahhan, Ayman Samman, Kelli, Heval Mohamed, Ramadan, Ronnie, Pimple, Pratik, Sandesara, Pratik, Shah, Amit J, Ward, Laura, Ko, Yi-An, Sun, Yan, Uphoff, Irina, Pearce, Brad, Garcia, Ernest V, Kutner, Michael, Bremner, J. Douglas, Esteves, Fabio, Sheps, David S, Raggi, Paolo, Vaccarino, Viola, Quyyumi, Arshed A
• Format: Article
• Language: English
• Subjects: Aged; Arterial stiffness; Cardiovascular; Catecholamines; Catecholamines - blood; Conventional stress test; Coronary Artery Disease - blood; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - physiopathology; Endothelial dysfunction; Exercise Test - methods; Exercise Test - psychology; Female; Hemodynamics - physiology; Humans; Male; Mental stress; Middle Aged; Myocardial ischemia; Myocardial Ischemia - blood; Myocardial Ischemia - diagnostic imaging; Myocardial Ischemia - physiopathology; Myocardial Perfusion Imaging - methods; Peripheral arterial tonometry; Prospective Studies; Stress, Psychological - blood; Stress, Psychological - diagnostic imaging; Stress, Psychological - physiopathology; Vasoconstriction; Vasoconstriction - physiology; Vasomotor System - metabolism
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2017.05.093

Abstract 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.