title: C-reactive protein and vulnerability to mental stress-induced myocardial ischemia.
abstract: Myocardial ischemia provoked in the laboratory during mental stress (MSI) in patients with stable coronary artery disease (CAD) predicts subsequent clinical events. The pathophysiology of MSI differs from that of exercise ischemia, and the mechanisms tying MSI to poor prognosis are not known. C-reactive protein (CRP) is a risk marker for cardiovascular events in patients with CAD, but little is known regarding the relationship of CRP to MSI. The purpose of this study was to examine the association of CRP to risk of MSI in CAD patients. Eighty-three patients with stable CAD underwent simultaneous single-photon emission computed tomography (SPECT) imaging with technetium-99m tetrofosmin myocardial perfusion imaging (MPI) and transthoracic echocardiography (TTE), at rest and during MS induced by laboratory mental stress. Serum CRP levels were measured 24 h after MS. MSI was defined by the presence of a new perfusion defect on SPECT and/or new regional wall motion abnormality on TTE during MS. Of the 83 patients, 30 (36%) developed MSI. There was no difference in gender, sex, BMI, histories of diabetes, hypertension, smoking, lipid profile, medications used (including statins, beta-blockers, ACE inhibitors, and aspirin), or hemodynamic response during MS between those with and without MSI. In univariate logistic regression analysis, each unit (1 mg/L) increase in CRP level was associated with 20% higher risk of MSI (OR 1.2, 95% CI 1.01-1.39, P=.04). This relationship remained in multivariate models. These data suggest that levels of CRP may be a risk marker for MSI in patients with CAD.
authors: Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT 06520-8017, USA.
authors: Rahman
authors: R
authors: Shah
authors: Matthew M
authors: MM
authors: Burg
authors: Aseem
authors: A
authors: Vashist
authors: Dorothea
authors: D
authors: Collins
authors: Joyce
authors: J
authors: Liu
authors: Farid
authors: F
authors: Jadbabaie
authors: Brendon
authors: B
authors: Graeber
authors: Christine
authors: C
authors: Earley
authors: Rachel
authors: R
authors: Lampert
authors: Robert
authors: R
authors: Soufer
mesh_terms: D001794:Blood Pressure; D002097:C-Reactive Protein / Q000378:metabolism*; D003327:Coronary Disease / Q000097:blood* / Q000000981:diagnostic imaging / Q000523:psychology; D004452:Echocardiography; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000503:physiopathology / Q000523:psychology*; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D013315:Stress, Psychological; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C078700:technetium tc-99m tetrofosmin; D002097:C-Reactive Protein