Abstract 14052: Mental Stress is Associated with More Transient Ischemic Dilatation of the Left Ventricle Than Physical Stress
Objective: Mental stress (MS) has been postulated to worsen coronary microvascular function. Mental stress-induced ischemia (MSI) predicts adverse events but does not correlate with CAD severity. Transient ischemic dilation (TID) detected with myocardial perfusion imaging is a measure of dilation in left ventricular cavity size with stress. However, TID may also reflect subendocardial hypoperfusion and impaired coronary flow reserve due to coronary microvascular disease. We addressed the hypotheses that MS is associated with larger TID as compared to physical stress (PS), and that patients with MSI have the largest TID.
Methods: 478 patients with CAD underwent 99mTc[[Unable to Display Character: ‐]]sestamibi myocardial perfusion imaging at rest and following both mental and physical (exercise/ pharmacological) stress testing. TID with each stress was calculated using Emory Cardiac Toolbox software. A 17-segments model was used to calculate summed stress scores to quantify perfusion defects with MS, PS, and at rest. TID with each stress condition and the difference between the two stress conditions were compared according to ischemia status.
Results: Ninety-three patients (19%) developed mental stress ischemia (MSI+), 131 (27%) developed physical stress ischemia (PSI+); 50 (10%) developed both MSI and PSI. Both MS and PS were associated with TID, but MS was associated with a larger increase in TID than PS (within-subject delta (δ) MS [[Unable to Display Character: –]] PS) = 0.02, p = 0.003). This difference was significantly larger in MSI+ patients (δMSI+ = 0.05, p = 0.002) than in MSI negative subjects (δMSI- = 0.01, p = 0.18). In contrast, PSI+ had a similar TID with PS and MS (δPSI+ = -0.003, p = 0.80). These results remained unaltered after adjustment by sociodemographic factors (age, sex, race, smoking status) and medical history (hypertension, hyperlipidemia and diabetes).
Conclusion: Mental stress is associated with TID, particularly in subjects who are MSI positive. TID may be a marker of subendocardial ischemia and coronary microvascular dysfunction in response to mental stress.
Author Disclosures: P.M. Pimple: None. E.V. Garcia: Ownership Interest; Significant; Emory Toolbox Software. J. Nye: None. I. Al Mheid: None. K. Wilmot: None. R. Ramadan: None. A.J. Shah: None. P. Raggi: None. F. Esteves: None. M. Kutner: None. Q. Long: None. J. Bremner: None. A.A. Quyyumi: None. V. Vaccarino: None.
- © 2014 by American Heart Association, Inc.