Peripheral Vasoconstriction During Mental Stress and Adverse Cardiovascular Outcomes in Patients With Coronary Artery Disease

• Type of Material: Article
• Authors: Jeong Hwan Kim, Emory University; Zakaria Almuwaqqat, Emory University; Muhammad Hammadah, Emory University; Chang Liu, Emory University; Yi-An Ko, Emory University; Bruno Lima, Emory University; Samaah Sullivan, Emory University; Ayman Alkhoder, Emory University; Rami Abdulbaki, Emory University; Laura Ward, Emory University; J. Douglas Bremner, Emory University; David S. Sheps, University of Florida; Paolo Raggi, Emory University; Yan Sun, Emory University; Amit Shah, Emory University; Viola Vaccarino, Emory University; Arshed Quyyumi, Emory University
• Language: English
• Date: 2019-10-25
• Publisher: LIPPINCOTT WILLIAMS & WILKINS
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2019, Wolters Kluwer Health
• Final Published Version (URL): http://dx.doi.org/10.1161/CIRCRESAHA.119.315005
• Title of Journal or Parent Work: CIRCULATION RESEARCH
• Volume: 125
• Issue: 10
• Start Page: 874
• End Page: 883
• Grant/Funding Information: This work was supported by the NIH (P01 HL101398, P20HL113451-01, P01HL086773-06A1, R56HL126558-01, R01 HL109413, R01HL109413-02S1, UL1TR000454, KL2TR000455, K23HL127251, K24HL077506, K24 MH076955, and K12HD085850). Also supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number UL1TR002378, TL1TR002382. The sponsors of this study had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.
• Keywords: vasoconstriction; Cardiovascular System & Cardiology; MYOCARDIAL-ISCHEMIA; DAILY-LIFE; myocardial infarction; INFARCTION; ATHEROSCLEROSIS; stress; Hematology; Life Sciences & Biomedicine; RISK; Science & Technology; VASOMOTOR RESPONSE; ENDOTHELIN; Cardiac & Cardiovascular Systems; SEX-DIFFERENCES; coronary artery disease; BLOOD-PRESSURE; ARRHYTHMIAS; Peripheral Vascular Disease

Abstract

RATIONALE: Excessive vasoconstriction in response to mental stress may be a potential mechanism by which acute psychological stress leads to adverse cardiac events. OBJECTIVES: We investigated whether excessive digital vasoconstriction during acute mental stress predicts adverse cardiovascular outcomes among patients with coronary artery disease. METHODS AND RESULTS: Five hundred forty-nine patients with stable coronary artery disease (age 63±9, 76% male, 29% black) underwent mental stress testing with a standardized public speaking stressor and followed prospectively for cardiovascular end points. Digital pulse wave amplitude was continuously measured using peripheral artery tonometry (PAT, Itamar Inc). Stress/rest PAT ratio (sPAT) of pulse wave amplitude during mental stress/baseline was calculated and dichotomized by the median value into low and high sPAT ratio groups. Upon 3-year follow-up, Fine and Gray's subdistribution hazard ratios were used to examine the association between sPAT ratio and the composite end point of cardiovascular death, myocardial infarction, revascularization, and hospitalization for heart failure. The median sPAT ratio was 0.68 (interquartile range, 0.48-0.88), indicating 32% vasoconstriction with mental stress. Men were more likely to have low sPAT ratio than women (odds ratio, 1.79; P=0.007) while those on β-blockers were less likely to have low sPAT ratio (odds ratio, 0.52; P=0.003). After adjusting for demographic and cardiovascular risk factors, medications, and rate-pressure product change during mental stress, those with low sPAT ratio were at significantly higher risk of adverse outcomes (subdistribution hazard ratio, 1.77 [95% CI, 1.12-2.80]). CONCLUSIONS: Greater peripheral vasoconstriction with mental stress, denoted by a low sPAT ratio, is associated with a higher risk of adverse cardiovascular outcomes in patients with coronary artery disease.