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

• Authors: Muhammad Hammadah, Emory University; Ibhar Al Mheid, Emory University; Kobina Wilmot, Emory University; Ronnie Ramadan, Emory University; Amit J. Shah, Emory University; Yan Sun, Emory University; Brad Pearce, Emory University; Ernest V Garcia, Emory University; Michael Kutner, Emory University; J. Douglas Bremner, Emory University; Fabio Esteves, Emory University; Paolo Raggi, Emory University; David Sheps, University of Florida; Viola Vaccarino, Emory University; Arshed Ali Quyyumi, Emory University
• Journal Title: Psychosomatic Medicine
• Volume: Volume 79, Number 3
• Publisher: Lippincott, Williams & Wilkins | 2017-04-01, Pages 311-317
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1097/PSY.0000000000000442
• Subjects: Health Sciences, Epidemiology; Health Sciences, Public Health; Psychology, General
• 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

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.