title: Platelet aggregation and mental stress induced myocardial ischemia: Results from the Responses of Myocardial Ischemia to Escitalopram Treatment (REMIT) study.
abstract: BACKGROUND
  Mental stress-induced myocardial ischemia (MSIMI) is common in patients with ischemic heart disease (IHD) and associated with a poorer cardiovascular prognosis. Platelet hyperactivity is an important factor in acute coronary syndrome. This study examined associations between MSIMI and resting and mental stress-induced platelet activity.
  
  
  METHODS
  Eligible patients with clinically stable IHD underwent a battery of 3 mental stress tests during the recruitment phase of REMIT study. MSIMI was assessed by echocardiography and electrocardiography. Ex vivo platelet aggregation in response to ADP, epinephrine, collagen, serotonin, and combinations of serotonin plus ADP, epinephrine, and collagen were evaluated as was platelet serotonin transporter expression.
  
  
  RESULTS
  Of the 270 participants who completed mental stress testing, and had both resting and post-stress platelet aggregation evaluation , 43.33% (n=117) met criteria for MSIMI and 18.15% (n=49) had normal left ventricular response to stress (NLVR). The MSIMI group, relative to the NLVR groups, demonstrated heightened mental stress-induced aggregation responses, as measured by area under the curve, to collagen 10μM (6.95[5.54] vs. -14.23[8.75].; P=0.045), epinephrine 10μM (12.84[4.84] vs. -6.40[7.61].; P=0.037) and to serotonin 10 μM plus ADP 1 μM (6.64[5.29] vs. -27.34[8.34]; P<.001). The resting platelet aggregation and serotonin transporter expression, however, were not different between the two groups.
  
  
  CONCLUSIONS
  These findings suggest that the dynamic change of platelet aggregation caused by mental stress may underlie MSIMI. While the importance of these findings requires additional investigation, they raise concern given the recognized relationship between mental stress-induced platelet hyperactivity and cardiovascular events in patients with IHD.
authors.affiliation: Department of Psychiatry, Duke University Medical Center, Durham, NC; Department of Medicine, Duke University Medical Center, Durham, NC. Electronic address: jiang001@mc.duke.edu.
authors.forename: Wei
authors.initials: W
authors.lastname: Jiang
authors.affiliation: Department of Psychiatry, Duke University Medical Center, Durham, NC.
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Boyle
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, NC.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Ortel
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, NC.
authors.forename: Zainab
authors.initials: Z
authors.lastname: Samad
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Durham, NC.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Velazquez
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, NC.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Harrison
authors.affiliation: Department of Psychiatry, Duke University Medical Center, Durham, NC.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Wilson
authors.affiliation: Department of Pharmacology & Cancer Biology, Duke University, Durham, NC.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Kuhn
authors.affiliation: Department of Psychiatry, Duke University Medical Center, Durham, NC.
authors.forename: Redford B
authors.initials: RB
authors.lastname: Williams
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Durham, NC.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
authors.affiliation: Department of Medicine, University of Cincinnati, Cincinnati, OH.
authors.forename: Richard C
authors.initials: RC
authors.lastname: Becker
mesh_terms: D015283:Citalopram / Q000627:therapeutic use*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood / Q000209:etiology*; D010974:Platelet Aggregation / Q000502:physiology*; D012372:ROC Curve; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D013315:Stress, Psychological / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D015283:Citalopram; D017367:Selective Serotonin Reuptake Inhibitors
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