title: Role of behavioral and psychological factors in mental stress-induced silent left ventricular dysfunction in coronary artery disease.
abstract: OBJECTIVE
  We examined the relationship of the psychological profile to left ventricular dysfunction induced during mental stress.
  
  
  BACKGROUND
  The contribution of psychological factors to mental stress-provoked silent myocardial ischemia has not been explored.
  
  
  METHODS
  Thirty patients with chronic stable coronary artery disease and a reversible defect on stress thallium-201 imaging completed a psychological assessment by questionnaire and Structured Interview, serially administered mental stress and brief walking exercise. Blood pressure, electrocardiogram (ECG) and left ventricular indexes were obtained by ambulatory serial radionuclide ventriculography. Silent ventricular dysfunction was defined by a decrease > or = 0.05 in ejection fraction or > or = 1 mm in ST segment on the ECG in the absence of symptoms.
  
  
  RESULTS
  Of the 30 patients, 15 (Group I) had evidence of silent left ventricular dysfunction during mental arithmetic. The other 15 (Group II) showed no change. In addition, 18 of 30 patients had this dysfunction during the Structured Interview. Both ischemic and nonischemic groups developed comparable and significant increases in heart rate and blood pressure. Group I patients were distinguished by higher scores on measures of aggressive responding (p < 0.001), trait anger (p < 0.0001), hostile affect (p < 0.003) and an index of behavioral reactivity (p < 0.003) and a lower score on anger control (p < 0.001). No other variables, including historical and clinical indexes, discriminated between the two groups.
  
  
  CONCLUSIONS
  Patients with coronary artery disease and mental stress-provoked silent ventricular dysfunction were distinguished by a psychological profile consistent with emotional reactivity to social interaction and mental provocation, with anger as the predominant affective state. Patients with such a profile may be at risk of frequent silent left ventricular dysfunction.
authors.affiliation: Cardiovascular Nuclear Medicine Service, Veterans Affairs Medical Center, West Haven, Connecticut 06516.
authors.forename: M M
authors.initials: MM
authors.lastname: Burg
authors.forename: D
authors.initials: D
authors.lastname: Jain
authors.forename: R
authors.initials: R
authors.lastname: Soufer
authors.forename: R D
authors.initials: RD
authors.lastname: Kerns
authors.forename: B L
authors.initials: BL
authors.lastname: Zaret
mesh_terms: D000328:Adult; D000368:Aged; D003327:Coronary Disease / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D011581:Psychological Tests; D013315:Stress, Psychological / Q000150:complications*; D013318:Stroke Volume; D014434:Type A Personality; D016277:Ventricular Function, Left