Angina and mental stress-induced myocardial ischemia.
Mental stress-induced myocardial ischemia is a common phenomenon in patients with coronary artery disease (CAD) and an emerging prognostic factor. Mental stress ischemia is correlated with ambulatory ischemia. However, whether it is related to angina symptoms during daily life has not been examined.



We assessed angina frequency (past month) in 98 post-myocardial infarction (MI) subjects (age 18-60 years) using the Seattle Angina Questionnaire. Patients underwent [(99m)Tc]sestamibi SPECT perfusion imaging at rest, after mental stress, and after exercise/pharmacological stress. Summed scores of perfusion abnormalities were obtained by observer-independent software. A summed difference score (SDS), the difference between stress and rest scores, was used to quantify myocardial ischemia under both stress conditions.



The mean age was 50 years, 50% were female and 60% were non-white. After adjustment for age, sex, smoking, CAD severity, depressive, anger, and anxiety symptoms, each 1-point increase in mental stress-SDS was associated with 1.73-unit increase in the angina frequency score (95% CI: 0.09-3.37) and 17% higher odds of being in a higher angina frequency category (OR: 1.17, 95% CI: 1.00-1.38). Depressive symptoms were associated with 12% higher odds of being in a higher angina frequency category (OR: 1.12, 95% CI: 1.03-1.21). In contrast, exercise/pharmacological stress-induced SDS was not associated with angina frequency.



Among young and middle-aged post-MI patients, myocardial ischemia induced by mental stress in the lab, but not by exercise/pharmacological stress, is associated with higher frequency of retrospectively reported angina during the day. Psychosocial stressors related to mental stress ischemia may be important contributory factor to daily angina.
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Pratik
P
Pimple
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
Amit J
AJ
Shah
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Cherie
C
Rooks
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
J Douglas
JD
Bremner
Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA.
Jonathon
J
Nye
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Ijeoma
I
Ibeanu
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA; Mazankowski Alberta Heart Institute, University of Alberta School of Medicine, Edmonton, Alberta, Canada.
Paolo
P
Raggi
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA. Electronic address: viola.vaccarino@emory.edu.
Viola
V
Vaccarino
D000328:Adult; D000787:Angina Pectoris / Q000209:etiology / Q000523:psychology*; D001007:Anxiety / Q000150:complications; D003324:Coronary Artery Disease / Q000150:complications*; D015444:Exercise / Q000523:psychology*; D005080:Exercise Test; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications*; D017202:Myocardial Ischemia / Q000150:complications; D019275:Radiopharmaceuticals; D012146:Rest; D012189:Retrospective Studies; D013315:Stress, Psychological / Q000150:complications*; D011795:Surveys and Questionnaires; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods
D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi
Angina; Coronary artery disease; Stress