Usefulness of ischemic response to mental stress in predicting silent myocardial ischemia during ambulatory monitoring

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Abstract

To evaluate the relation of mental stress-induced ischemia to silent ischemia on ambulatory monitoring, 46 patients with stable coronary artery disease underwent standardized laboratory mental stress and exercise treadmill testing according to National Institutes of Health protocol during which left ventricular ejection fraction (EF) was determined using the nuclear VEST. Life stress, type A behavior, and hostility were determined using standard interviews. Subsequently, 48-hour ambulatory electrocardiographic monitoring was performed. Twenty-three patients (50%) had an ischemic response (left ventricular EF decrease ≥5%) to mental stress, which was associated with ambulatory ischemia (13 of 19 with ambulatory ischemia had mental stress-induced ischemia vs 10 of 27 without ambulatory ischemia, p = 0.04). Left ventricular EF response to mental stress was a significant predictor of ambulatory ischemia independent of EF response to exercise (F = 4.8, p = 0.03). Patients with mental stress-induced ischemia had longer total duration (31.4 ± 57.0 vs 8.3 ± 18 minutes, p = 0.06) and more frequent episodes of ambulatory ischemia (3.1 ± 4.6 vs 0.9 ± 1.9 episodes, p = 0.03). Life stress, type A behavior, and hostility were not associated with prevalence or severity of ambulatory ischemia. In conclusion, an ischemic response to mental stress is significantly associated with higher prevalence, longer duration, and more frequent episodes of ambulatory ischemia.

References (30)

  • A Rozanski et al.

    Mental stress and the induction of silent myocardial ischemia in patients with coronary artery disease

    N Engl J Med

    (1978)
  • JR Jennings et al.

    Task-induced ST segment depression, ectopic beats, and autonomic responses in coronary heart disease patients

    Psychosom Med

    (1985)
  • JE Deanfield et al.

    Silent myocardial ischaemia due to mental stress

    Lancet

    (1984)
  • AC Yeung et al.

    The effect of atherosclerosis on the vasomotor response of coronary arteries to mental stress

    N Engl J Med

    (1991)
  • SE Legault et al.

    The pathophysiology and time course of silent myocardial ischemia during mental stress—clinical, anatomic and physiologic correlates

    Br Heart J

    (1995)
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    This study was supported by the Heart & Stroke Foundation of Ontario.

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