Abstract 15691: Myocardial Annular Velocity Change During Mental Stress Predicts Outcome in Patients With Stable Coronary Artery Disease
Introduction: Mental stress-induced myocardial ischemia (MSIMI) is common and a prognostic factor of adverse cardiovascular outcomes in patients with coronary artery disease (CAD). While baseline myocardial dysfunction is known to underlie the risk associated with MSIMI, the pathogenic effects of changes in myocardial dysfunction due to mental stress are not well understood.
Hypothesis: The present study focuses on the examining associations between changes in mental stress-induced myocardial annular velocities (MAV) and cardiovascular outcome in CAD patients.
Methods: MAV, specifically, diastolic early (e′), diastolic late (a′), and systolic (s′) velocities, were obtained at rest and during mental stress testing in 224 patients with clinically stable CAD. Using multivariable Cox regression models age, sex, and baseline adjusted mental stress-induced MAV measures were examined as predictors of an a priori defined composite of major adverse cardiovascular event (MACE) defined as all-cause mortality and/or non-fatal cardiovascular events resulting in an unplanned hospitalization. Patients were followed annually for up to a six year period.
Results: A total of 224 patients (mean age 63, 83.5% female) formed the study population. During follow up (median 4.0 y int. quartile range 2.5 - 5 y) a total of 86 patients experienced at least one MACE. Resting levels of e’ and a’ were significant predictors of MACE (p <.05), and resting level of s’ was marginality related to MACE (p=.06). Further, MS induced changes in e’ (HR = .73) and s’ (HR =.73) were significant (p < .05) predictors of MACE, and the change in a’ (HR = .74) was marginal (p = .05). The pattern of the relation for each MAV measure was such that patients with lower and/or greater decreases in e′ and/or s’ had a higher probability of experiencing a MACE. The associations between MS induced values of e’ and a’ for MACE were independent of resting levels.
Conclusions: Mental stress-induced MAV changes independently predict adverse cardiovascular outcomes in patients with stable CAD.
Author Disclosures: F.A. Alenezi: None. B. Brummett: None. S. Boyle: None. Z. Samad: Research Grant; Modest; Gilead Sciences, Boston-Scientific-Duke Strategic Alliance for Research, Medtronic-Duke Strategic Alliance for Research. M. Babyak: None. J. Wilson: None. J. Sun: None. B. Sedberry: None. M. Ersboll: None. C. O’Connor: None. S. Shah: None. E. Velazquez: None. W. Jiang: None.
- © 2016 by American Heart Association, Inc.