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

• Type of Material: Article
• Authors: Muhammad Hammadah, Emory University; Ayman Alkhoder, Emory University; Ibhar Al Mheid, Emory University; Kobina Wilmot, Emory University; Nino Isakadze, Emory University; Naser Abdulhadi, Emory University; Danielle Chou, Emory University; Malik Obideen, Emory University; Wesley T. O'Neal, Emory University; Samaah Sullivan, Emory University; Ayman Samman Tahhan, Emory University; Heval Mohamed Kelli, Emory University; Ronnie Ramadan, Emory University; Pratik Pimple, Emory University; Pratik Sandesara, Emory University; Amit Shah, Emory University; Laura Ward, Emory University; Yi-An Ko, Emory University; Yan Sun, Emory University; Irina Uphoff, Emory University; Bradley Pearce, Emory University; Ernest Garcia, Emory University; Michael Kutner, Emory University; James Bremner, Emory University; Fabio Esteves, Emory University; David S. Sheps, University of Florida; Paolo Raggi, Emory University; Laura Vaccarino, Emory University; Arshed Quyyumi, Emory University
• Language: English
• Date: 2017-09-15
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017 Elsevier B.V.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.ijcard.2017.05.093
• Title of Journal or Parent Work: International Journal of Cardiology
• ISSN: 0167-5273
• Volume: 243
• Start Page: 47
• End Page: 53
• Grant/Funding Information: 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.; This work was supported by the NIH (P01 HL101398, P20HL113451-01, P01HL086773-06A1, R56HL126558-01, R01 HL109413, R01HL109413-02S1, UL1TR000454, KL2TR000455, K24HL077506, and K24 MH076955).; Dr. Garcia receives royalties from the sale of the Emory Cardiac Toolbox, used for some analyses in this study.; Dr. Vaccarino, Dr. Quyyumi, Dr.Bremner, Dr.Shah, Dr.Sheps, and Dr.O’Neal report research support from NIH.
• Keywords: CARDIAC EVENTS; Life Sciences & Biomedicine; Science & Technology; Peripheral arterial tonometry; ENDOTHELIAL DYSFUNCTION; METAANALYSIS; Myocardial ischemia; Cardiac & Cardiovascular Systems; PSYCHOPHYSIOLOGICAL INVESTIGATIONS; Arterial stiffness; Cardiovascular System & Cardiology; FLOW; VASOCONSTRICTION; Vasoconstriction Mental stress; LEFT-VENTRICULAR DYSFUNCTION; MECHANISMS; STIFFNESS; Conventional stress test; Catecholamines Endothelial dysfunction; CORONARY-ARTERY-DISEASE
• Research Categories: Health Sciences, Radiology; Health Sciences, Pathology; Biology, Biostatistics

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.