(Circulation. 1995;92:2102-2108.)
© 1995 American Heart Association, Inc.
Articles |
Mental Stress–Induced Ischemia in the Laboratory and Ambulatory Ischemia During Daily Life
Association and Hemodynamic Features
From the Department of Psychiatry and Behavioral Sciences (J.A.B., W.J., M.B., E.T.T.), the Department of Medicine (R.A.W., D.J.F., J.J.M., C.O.), and the Department of Radiology (R.E.C., M.H.), Duke University Medical Center, Durham, NC; and the Department of Medical and Clinical Psychology (D.S.K.), Uniformed Services University of the Health Sciences, Bethesda, Md.
Correspondence to Dr James Blumenthal, Box 3119, Division of Behavioral Medicine, Duke University Medical Center, Durham, NC 27710.
Background The purpose of this study was to determine the correspondence of mental stress–induced ischemia in the laboratory with ambulatory ischemia and to assess the relationship between hemodynamic responses to mental stress and the occurrence of ischemia. Although exercise testing is usually used to elicit myocardial ischemia, ischemia during daily life usually occurs at relatively low heart rates and in the absence of strenuous physical exercise. Mental stress has been shown to trigger ischemic events in the laboratory at lower heart rates but at blood pressures comparable to exercise. We therefore compared the extent to which mental stress and exercise testing identify patients who develop ischemia out of hospital.
Methods and Results One hundred thirty-two patients with documented coronary disease and recent evidence of exercise-induced myocardial ischemia underwent 48-hour ambulatory monitoring and radionuclide ventriculography during exercise and mental stress testing. Patients who displayed mental stress–induced ischemia in the laboratory were more likely to exhibit ischemia during daily life (P<.021). Furthermore, patients who exhibited ischemia during ambulatory monitoring displayed larger diastolic blood pressure (P<.006), heart rate (P<.039), and rate-pressure product responses (P<.018) during mental stress.
Conclusions Among patients with prior positive exercise stress tests, mental stress–induced ischemia, defined by new wall motion abnormalities, predicts daily ischemia independent of exercise-induced ischemia. Exaggerated hemodynamic responses during mental stress testing also identify individuals who are more likely to exhibit myocardial ischemia during daily life and mental stress.
Key Words: ischemia • stress • hemodynamics
This article has been cited by other articles:
 |
|
 |
|
  M. Hassan, K. M. York, H. Li, Q. Li, Y. Gong, T. Y. Langaee, R. B. Fillingim, J. A. Johnson, and D. S. Sheps Association of {beta}1-Adrenergic Receptor Genetic Polymorphism With Mental Stress-Induced Myocardial Ischemia in Patients With Coronary Artery Disease Arch Intern Med, April 14, 2008; 168(7): 763 - 770. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. D. Holmes, D. S. Krantz, W. J. Kop, A. Del Negro, P. Karasik, and J. S. Gottdiener Mental Stress Hemodynamic Responses and Myocardial Ischemia: Does Left Ventricular Dysfunction Alter These Relationships? Psychosom Med, July 1, 2007; 69(6): 495 - 500. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Hizume, K. Morikawa, A. Takaki, K. Abe, K. Sunagawa, M. Amano, K. Kaibuchi, C. Kubo, and H. Shimokawa Sustained Elevation of Serum Cortisol Level Causes Sensitization of Coronary Vasoconstricting Responses in Pigs In Vivo: A Possible Link Between Stress and Coronary Vasospasm Circ. Res., September 29, 2006; 99(7): 767 - 775. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Ramachandruni, R. B. Fillingim, S. P. McGorray, C. M. Schmalfuss, G. R. Cooper, R. S. Schofield, and D. S. Sheps Mental Stress Provokes Ischemia in Coronary Artery Disease Subjects Without Exercise- or Adenosine-Induced Ischemia J. Am. Coll. Cardiol., March 7, 2006; 47(5): 987 - 991. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Taggart, P. Sutton, C. Redfern, V. N. Batchvarov, K. Hnatkova, M. Malik, U. James, and A. Joseph The Effect of Mental Stress on the Non-Dipolar Components of the T Wave: Modulation by Hypnosis Psychosom Med, May 1, 2005; 67(3): 376 - 383. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. A. Blumenthal, A. Sherwood, M. A. Babyak, L. L. Watkins, R. Waugh, A. Georgiades, S. L. Bacon, J. Hayano, R. E. Coleman, and A. Hinderliter Effects of Exercise and Stress Management Training on Markers of Cardiovascular Risk in Patients With Ischemic Heart Disease: A Randomized Controlled Trial JAMA, April 6, 2005; 293(13): 1626 - 1634. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. MONTEBUGNOLI, D. SERVIDIO, R. A. MIATON, and C. PRATI Heart rate variability: A sensitive parameter for detecting abnormal cardiocirculatory changes during a stressful dental procedure J Am Dent Assoc, December 1, 2004; 135(12): 1718 - 1723. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. M. Burg, R. Lampert, T. Joska, W. Batsford, and D. Jain Psychological Traits and Emotion-Triggering of ICD Shock-Terminated Arrhythmias Psychosom Med, November 1, 2004; 66(6): 898 - 902. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Sherwood, J. W. Hughes, C. Kuhn, and A. L. Hinderliter Hostility Is Related to Blunted {beta}-Adrenergic Receptor Responsiveness Among Middle-Aged Women Psychosom Med, July 1, 2004; 66(4): 507 - 513. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. J. Kop, D. S. Krantz, B. D. Nearing, J. S. Gottdiener, J. F. Quigley, M. O'Callahan, A. A. DelNegro, T. D. Friehling, P. Karasik, S. Suchday, et al. Effects of Acute Mental Stress and Exercise on T-Wave Alternans in Patients With Implantable Cardioverter Defibrillators and Controls Circulation, April 20, 2004; 109(15): 1864 - 1869. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P.C Strike and A Steptoe Systematic review of mental stress-induced myocardial ischaemia Eur. Heart J., April 2, 2003; 24(8): 690 - 703. [Full Text] [PDF]
|
|
|
|
|
|
W. J. Kop, R. J. Verdino, J. S. Gottdiener, S. T. O'Leary, C. N. Bairey Merz, and D. S. Krantz Changes in heart rate and heart rate variability before ambulatory ischemic events J. Am. Coll. Cardiol., September 1, 2001; 38(3): 742 - 749. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Michalsen and G. Dobos Acute stress and ventricular arrhythmias Eur. Heart J., April 2, 2001; 22(8): 712 - 712. [PDF]
|
|
|
|
|
|
W. J. Kop, D. S. Krantz, R. H. Howell, M. A. Ferguson, V. Papademetriou, D. Lu, J. J. Popma, J. F. Quigley, M. Vernalis, and J. S. Gottdiener Effects of mental stress on coronary epicardial vasomotion and flow velocity in coronary artery disease: relationship with hemodynamic stress responses J. Am. Coll. Cardiol., April 1, 2001; 37(5): 1359 - 1366. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Denollet, J. Vaes, and D. L. Brutsaert Inadequate Response to Treatment in Coronary Heart Disease : Adverse Effects of Type D Personality and Younger Age on 5-Year Prognosis and Quality of Life Circulation, August 8, 2000; 102(6): 630 - 635. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. Blumenthal, A. Sherwood, E. C. D. Gullette, M. Babyak, R. Waugh, A. Georgiades, L. W. Craighead, D. Tweedy, M. Feinglos, M. Appelbaum, et al. Exercise and Weight Loss Reduce Blood Pressure in Men and Women With Mild Hypertension: Effects on Cardiovascular, Metabolic, and Hemodynamic Functioning Arch Intern Med, July 10, 2000; 160(13): 1947 - 1958. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Hemingway, M. Shipley, P. Macfarlane, and M. Marmot Impact of socioeconomic status on coronary mortality in people with symptoms, electrocardiographic abnormalities, both or neither: the original Whitehall study 25 year follow up J Epidemiol Community Health, July 1, 2000; 54(7): 510 - 516. [Abstract] [Full Text]
|
|
|
|
|
|
D. S. Krantz, D. S. Sheps, R. M. Carney, and B. H. Natelson Effects of Mental Stress in Patients With Coronary Artery Disease: Evidence and Clinical Implications JAMA, April 12, 2000; 283(14): 1800 - 1802. [Full Text] [PDF]
|
|
|
|
|
|
G. A. Beller and B. L. Zaret Contributions of Nuclear Cardiology to Diagnosis and Prognosis of Patients With Coronary Artery Disease Circulation, March 28, 2000; 101(12): 1465 - 1478. [Full Text] [PDF]
|
|
|
|
|
|
R. Lampert, D. Jain, M. M. Burg, W. P. Batsford, and C. A. McPherson Destabilizing Effects of Mental Stress on Ventricular Arrhythmias in Patients With Implantable Cardioverter-Defibrillators Circulation, January 18, 2000; 101(2): 158 - 164. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. L. Watkins, J. A. Blumenthal, P. R. Kowey, H. Z. Brandspiegel, R. A. Marinchak, and S. J. Rials Worried to Death? • Response Circulation, September 14, 1999; 100 (11): 1250 - 1252. [Full Text] [PDF]
|
|
|
|
|
|
D. S. Sheps, R. P. McMahon, K. C. Light, W. Maixner, C. J. Pepine, J. D. Cohen, A. D. Goldberg, R. Bonsall, R. Carney, P. H. Stone, et al. Low hot pain threshold predicts shorter time to exercise-induced angina: results from the psychophysiological investigations of myocardial ischemia (PIMI) study J. Am. Coll. Cardiol., June 1, 1999; 33(7): 1855 - 1862. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. H. Stone, D. S. Krantz, R. P. McMahon, A. D. Goldberg, L. C. Becker, B. R. Chaitman, H. A. Taylor, J. D. Cohen, K. E. Freedland, B. D. Bertolet, et al. Relationship among mental stress-induced ischemia and ischemia during daily life and during exercise: the Psychophysiologic Investigations of Myocardial Ischemia (PIMI) Study J. Am. Coll. Cardiol., May 1, 1999; 33(6): 1476 - 1484. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. A. Scheuer and S. W. Mifflin Repeated intermittent stress exacerbates myocardial ischemia-reperfusion injury Am J Physiol Regulatory Integrative Comp Physiol, February 1, 1998; 274(2): R470 - R475. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Denollet and D. L. Brutsaert Personality, Disease Severity, and the Risk of Long-term Cardiac Events in Patients With a Decreased Ejection Fraction After Myocardial Infarction Circulation, January 20, 1998; 97(2): 167 - 173. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. S. Sheps, R. P. McMahon, L. Becker, R. M. Carney, K. E. Freedland, J. D. Cohen, D. Sheffield, A. D. Goldberg, M. W. Ketterer, C. J. Pepine, et al. Mental Stress-Induced Ischemia and All-Cause Mortality in Patients With Coronary Artery Disease: Results From the Psychophysiological Investigations of Myocardial Ischemia Study Circulation, April 16, 2002; 105(15): 1780 - 1784. [Abstract] [Full Text] [PDF]
|
|