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Author Notes:

Arshed A Quyyumi, MD, PhD, Emory University, Department of Cardiology, Emory University School of medicine, 1462 Clifton Road N.E. Suite 507, Atlanta GA 30322, Phone: 404 727 3655; Fax: 404 712 8785; aquyyum@emory.edu.

We would like to thank Naser Abdulhadi, Ayman Alkhoder, Malik Obideen, Tene T. Lewis, and Oleksiy Levantsevych for their significant contributions to the MIPS study including patient enrollment and data collection.

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.

None of the other authors report conflict of interest relevant to this article.

Subjects:

Research Funding:

Dr. Vaccarino and Dr. Quyyumi report research support from NIH.

Ernest V. Garcia receives royalties from the sale of the Emory Cardiac Toolbox, used for some analyses in this study.

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).

Keywords:

  • Science & Technology
  • Social Sciences
  • Life Sciences & Biomedicine
  • Psychiatry
  • Psychology
  • Psychology, Multidisciplinary
  • mental stress
  • myocardial ischemia
  • coronary artery disease
  • prognosis
  • CORONARY-ARTERY-DISEASE
  • INDUCED MYOCARDIAL-ISCHEMIA
  • LEFT-VENTRICULAR DYSFUNCTION
  • PERCEIVED SOCIAL SUPPORT
  • PSYCHOMETRIC PROPERTIES
  • ENDOTHELIAL FUNCTION
  • CARDIAC EVENTS
  • PSYCHOPHYSIOLOGICAL INVESTIGATIONS
  • PERIPHERAL VASOCONSTRICTION
  • CARDIOVASCULAR-DISEASE

The Mental Stress Ischemia Prognosis Study (MIPS): Objectives, Study Design, and Prevalence of Inducible Ischemia

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Journal Title:

Psychosomatic Medicine

Volume:

Volume 79, Number 3

Publisher:

, Pages 311-317

Type of Work:

Article | Post-print: After Peer Review

Abstract:

Mental stress-induced myocardial ischemia (MSIMI) is a common phenomenon in patients with coronary artery disease (CAD), but contemporary studies of its prognostic significance and its underlying pathophysiology are limited. Methods: We prospectively enrolled patients with confirmed CAD in the Mental Stress Ischemia Prognosis Study (MIPS) between 2011 and 2014. All patients underwent mental stress testing using a standardized public speaking task, and ischemia was detected by 99m Tcsestamibi myocardial perfusion imaging. Patients also underwent conventional stress testing for myocardial ischemia (CSIMI) using exercise or pharmacological stress testing. Furthermore, digital microvascular flow, endothelial function, arterial stiffness, and blood sample collections were performed before, during, and after mental stress. Two-year adverse clinical outcomes are being assessed. Results: Six-hundred ninety-five patients completed baseline enrollment in the MIPS. Their mean (standard deviation) age was 62.9 (9.1) years, 72%were men, 30% were African American, and 32%had a history myocardial infarction. The prevalence of MSIMI and CSIMI is 16.1% and 34.7%, respectively. A total of 151 patients (22.9%) had only CSIMI, 28 (4.2%) had only MSIMI, and 78 (11.8%) had both MSIMI and CSIMI. Patients with ischemia had a lower ejection fraction and higher prevalence of previous coronary artery bypass grafting compared with those without inducible ischemia (p < .050). The prevalence of obstructive CAD was not statistically different between patients with and without MSIMI (p = .426); in contrast, it was higher in patients with CSIMI (p < .001). Conclusions: TheMIPS data will provide useful information to assess the prognostic significance and underlying mechanisms of MSIMI.

Copyright information:

© 2016 by the American Psychosomatic Society.

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