Abstract 12665: Impaired Resting Myocardial Annular Velocities are Independently Associated with Mental-stress Induced Ischemia in Patients with Coronary Heart Disease
Objective: Tissue Doppler myocardial velocities detect preclinical cardiac dysfunction and clinical outcome in a range of conditions. However, little is known about the interrelationship between annular myocardial velocities and the propensity for developing mental stress induced myocardial ischemia (MSIMI) versus exercise stress induced myocardial ischemia (ESIMI).
Methods: Resting annular myocardial tissue Doppler (TDI) velocities were obtained in 225 patients with known coronary heart disease who were subjected to both conventional exercise stress test as well as a battery of 3 mental stress tests. Diastolic early (e’) and late (a’) as well as systolic (s’) velocities were obtained and eas-index, an integrated measure of myocardial velocities, was calculated as e’/(a’ x s’). MSIMI was defined as 1) development or worsening of regional wall motion abnormality, 2) left ventricular ejection fraction reduction ≥ 8%, and/or 3) ischemic ST-segment changes during one or more of the three mental stress tests.
Results: A total of 98 (43.7%) out of 225 patients exhibited MSIMI. Patients developing MSIMI had significantly lower s’ (7.0±1.7 vs 7.5±1.2, p=0.016) and a’ (8.9±1.8 vs 10.0±1.9, p≤0.001) at baseline whereas e’ did not differ (6.5±1.7 vs. 6.5±1.8, p=0.85). Furthermore, the eas-index was significantly higher (0.11±0.04 vs. 0.09±0.03, p≤0.0001).The eas-index remained significantly associated with the propensity for developing MSIMI (Odds ratio per 0.05 unit increase: 1.85; 95%CI: 1.21-2.82, p=0.004) after adjustment of resting LVEF, resting wall motion index score, gender and social circumstances of living. There was no association between resting eas-index and ESIMI.
Conclusion: MSIMI but not ESIMI is independently associated with resting abnormalities in myocardial systolic and late diastolic velocities as well as the integrated measure of the eas-index in patients with known coronary artery disease.
- © 2013 by American Heart Association, Inc.