Abstract 15891: Relationship Between Peripheral Vascular Responses With Mental Stress and Mental Stress-induced Myocardial Ischemia
Background: Mental stress-induced myocardial ischemia (MSIMI) in patients with CAD is unrelated to its severity and is associated with adverse cardiovascular outcomes. The impact of vascular function and its response to mental stress (MS) on the development of MSIMI remains unclear. We measured endothelial function and arterial stiffness, and their change with MS, with the hypothesis that abnormalities in the vascular functional responses will contribute to MSIMI.
Methods: Patients with stable CAD underwent 99mTc sestamibi myocardial perfusion imaging during MS testing using a public speaking stressor. MSIMI was defined as impaired myocardial perfusion using a 17-segment model. Endothelial function [endothelium-dependent flow-mediated dilation (FMD)], microvascular reactivity [reactive hyperemia index (RHI, Endo-PAT2000)] and arterial stiffness [pulse wave velocity (PWV), Sphygmocor Inc.] were measured at rest and 30-min after MS.
Results: Of 457 patients with CAD aged 63±9 years (75% male), 87 (15.5%) developed MSIMI. FMD decreased [Median (IQR) change: -0.8 (-2.5 - 0.6)%, p=0.002], PWV increased [median (IQR) change: 0.3 (-0.7 - 1.2) m/s, p=0.025], but there was no change in RHI after MS (Figure). There were no significant differences in either the baseline or post-MS vascular measures between patients with and without MSIMI (Figure).
Conclusion: MS is associated with impairment of conductance vessel but not microvascular endothelial dysfunction and with increased arterial stiffness. The magnitude of these alterations is not a predictor of MSIMI in CAD.
Author Disclosures: M. Hammadah: None. M. Obideen: None. U. Irina: None. N. Abdelhadi: None. A. Alkhoder: None. O. Levantsevych: None. S. Fang: None. I. Ibeanu: None. H. Mohamed Kelli: None. P. Pimple: None. Z. Almuwaqqat: None. N. Isakadze: None. M. Moureiden: None. I. Al Mheid: None. R. Ramadan: None. K. Wilmot: None. A.J. Shah: None. B. Pearce: None. Y. Sun: None. E. Garcia: None. F. Esteves: None. P. Raggi: None. J. Bremner: None. V. Vaccarino: None. A. Quyyumi: None.
- © 2016 by American Heart Association, Inc.