title: Prevalence and clinical characteristics of mental stress-induced myocardial ischemia in patients with coronary heart disease.
abstract: OBJECTIVE
  The goal of this study was to evaluate the prevalence and clinical characteristics of mental stress-induced myocardial ischemia.
  
  
  BACKGROUND
  Mental stress-induced myocardial ischemia is prevalent and a risk factor for poor prognosis in patients with coronary heart disease, but past studies mainly studied patients with exercise-induced myocardial ischemia.
  
  
  METHODS
  Eligible patients with clinically stable coronary heart disease, regardless of exercise stress testing status, underwent a battery of 3 mental stress tests followed by a treadmill test. Stress-induced ischemia, assessed by echocardiography and electrocardiography, was defined as: 1) development or worsening of regional wall motion abnormality; 2) left ventricular ejection fraction reduction ≥ 8%; and/or 3) horizontal or downsloping ST-segment depression ≥ 1 mm in 2 or more leads lasting for ≥ 3 consecutive beats during at least 1 mental test or during the exercise test.
  
  
  RESULTS
  Mental stress-induced ischemia occurred in 43.45%, whereas exercise-induced ischemia occurred in 33.79% (p = 0.002) of the study population (N = 310). Women (odds ratio [OR]: 1.88), patients who were not married (OR: 1.99), and patients who lived alone (OR: 2.24) were more likely to have mental stress-induced ischemia (all p < 0.05). Multivariate analysis showed that compared with married men or men living with someone, unmarried men (OR: 2.57) and married women (OR: 3.18), or living alone (male OR: 2.25 and female OR: 2.72, respectively) had higher risk for mental stress-induced ischemia (all p < 0.05).
  
  
  CONCLUSIONS
  Mental stress-induced ischemia is more common than exercise-induced ischemia in patients with clinically stable coronary heart disease. Women, unmarried men, and individuals living alone are at higher risk for mental stress-induced ischemia. (Responses of Myocardial Ischemia to Escitalopram Treatment [REMIT]; NCT00574847).
authors: Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, North Carolina 27710, USA. jiang001@mc.duke.edu
authors: Wei
authors: W
authors: Jiang
authors: Zainab
authors: Z
authors: Samad
authors: Stephen
authors: S
authors: Boyle
authors: Richard C
authors: RC
authors: Becker
authors: Redford
authors: R
authors: Williams
authors: Cynthia
authors: C
authors: Kuhn
authors: Thomas L
authors: TL
authors: Ortel
authors: Joseph
authors: J
authors: Rogers
authors: Maragatha
authors: M
authors: Kuchibhatla
authors: Christopher
authors: C
authors: O'Connor
authors: Eric J
authors: EJ
authors: Velazquez
mesh_terms: D000368:Aged; D003327:Coronary Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D004452:Echocardiography / Q000523:psychology; D004562:Electrocardiography / Q000523:psychology; D005080:Exercise Test / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D015995:Prevalence; D012307:Risk Factors; D013315:Stress, Psychological / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology