Author + information
- Ronnie Ramadan,
- Shabnam Seydafkan,
- Ibhar Al Mheid,
- Fabio Esteves,
- David Sheps,
- J. Douglas Bremner,
- Viola Vaccarino and
- Arshed Quyyumi
Mental stress (MS) provokes myocardial ischemia in many patients with coronary artery disease (CAD). Arterial stiffness and endothelial dysfunction are important determinants of cardiovascular risk. We investigated the effect of MS on endothelial function and arterial stiffness, with the hypothesis that MS will provoke endothelial dysfunction and increased arterial stiffness.
Patients with CAD (n=212, 72% males, mean age of 65±8 years) underwent MS testing using a standardized public speaking task. Myocardial perfusion imaging with 99m-Tc-sestamibi was used to detect MS ischemia. We assessed 1) endothelial function as flow- mediated vasodilation (FMD) of the brachial artery, and 2) arterial stiffness as carotid-femoral pulse wave velocity (PWV), central augmentation index (CAIx), and subendocardial viability ratio (SEVR) using applanation tonometry (SphygmoCor) both at rest and 15 minutes after the MS task.
MS precipitated an increase in PWV (P<0.001), CAIx (p=0.02), and SEVR (p<0.001), and a decrease in FMD (p<0.001). MS ischemia occurred in 23 (11%) patients. There was no significant difference between those with or without MS ischemia in baseline vascular measures (PWV, CAIx, SEVR, FMD), or baseline peripheral hemodynamic measures. All vascular measures changed similarly in response to MS regardless of whether patients had MS ischemia or not, except for CAIx. Patients with MS ischemia had a significant increase in CAIx (p=0.009), whereas those without MSI had no change (p=0.1). The change in CAIx was an independent predictor for the development of MS ischemia after adjustment for age, sex, height, race, and hypertension (p=0.03). Systolic and diastolic blood pressure, and heart rate increased in response to MS (40±16 and 25±11 (mmHg), and 17±10 (bpm); P<0.001 for each), and this increase was similar between those with or without MS ischemia.
MS is associated with increased arterial stiffness and endothelial dysfunction in patients with CAD. Moreover, the increase in CAIx was predictive of MS ischemia. Whether repeated episodes of MS lead to lasting, negative impact on the endothelium and vascular health needs further investigation.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Mental Stress on the Heart
Abstract Category: 10. Chronic CAD/Stable Ischemic Heart Disease: Clinical
Presentation Number: 1108-60
- 2013 American College of Cardiology Foundation