title: The Mental Stress Ischemia Prognosis Study: Objectives, Study Design, and Prevalence of Inducible Ischemia.
abstract: OBJECTIVE
  Mental stress-induced myocardial ischemia (MSIMI) is a common phenomenon in patients with coronary artery disease (CAD), but contemporary studies of its prognostic significance and its underlying pathophysiology are limited.
  
  
  METHODS
  We prospectively enrolled patients with confirmed CAD in the Mental Stress Ischemia Prognosis Study (MIPS) between 2011 and 2014. All patients underwent mental stress testing using a standardized public speaking task, and ischemia was detected by Tc-sestamibi myocardial perfusion imaging. Patients also underwent conventional stress testing for myocardial ischemia (CSIMI) using exercise or pharmacological stress testing. Furthermore, digital microvascular flow, endothelial function, arterial stiffness, and blood sample collections were performed before, during, and after mental stress. Two-year adverse clinical outcomes are being assessed.
  
  
  RESULTS
  Six-hundred ninety-five patients completed baseline enrollment in the MIPS. Their mean (standard deviation) age was 62.9 (9.1) years, 72% were men, 30% were African American, and 32% had a history myocardial infarction. The prevalence of MSIMI and CSIMI is 16.1% and 34.7%, respectively. A total of 151 patients (22.9%) had only CSIMI, 28 (4.2%) had only MSIMI, and 78 (11.8%) had both MSIMI and CSIMI. Patients with ischemia had a lower ejection fraction and higher prevalence of previous coronary artery bypass grafting compared with those without inducible ischemia (p < .050). The prevalence of obstructive CAD was not statistically different between patients with and without MSIMI (p = .426); in contrast, it was higher in patients with CSIMI (p < .001).
  
  
  CONCLUSIONS
  The MIPS data will provide useful information to assess the prognostic significance and underlying mechanisms of MSIMI.
authors.affiliation: From the Division of Cardiology (Hammadah, Al Mheid, Wilmot, Ramadan, Shah, Vaccarino, Quyyumi), Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; Department of Epidemiology (Shah, Sun, Pearce, Raggi, Vaccarino), Rollins School of Public Health, Emory University, Atlanta, Georgia; Atlanta VA Medical Center (Shah, Bremner), Decatur, Georgia; Department of Radiology (Garcia, Esteves, Raggi), Emory University School of Medicine, Atlanta, Georgia; Department of Biostatistics and Bioinformatics (Kutner), Rollins School of Public Health, Emory University, Atlanta, Georgia; Department of Psychiatry and Behavioral Sciences (Bremner), Emory University School of Medicine; Mazankowski Alberta Heart Institute (Raggi), University of Alberta, Edmonton, Alberta, Canada; and Division of Cardiovascular Medicine (Sheps), Department of Medicine, University of Florida Health Science Center, Jacksonville, Florida.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Hammadah
authors.forename: Ibhar
authors.initials: I
authors.lastname: Al Mheid
authors.forename: Kobina
authors.initials: K
authors.lastname: Wilmot
authors.forename: Ronnie
authors.initials: R
authors.lastname: Ramadan
authors.forename: Amit J
authors.initials: AJ
authors.lastname: Shah
authors.forename: Yan
authors.initials: Y
authors.lastname: Sun
authors.forename: Brad
authors.initials: B
authors.lastname: Pearce
authors.forename: Ernest V
authors.initials: EV
authors.lastname: Garcia
authors.forename: Michael
authors.initials: M
authors.lastname: Kutner
authors.forename: J Douglas
authors.initials: JD
authors.lastname: Bremner
authors.forename: Fabio
authors.initials: F
authors.lastname: Esteves
authors.forename: Paolo
authors.initials: P
authors.lastname: Raggi
authors.forename: David S
authors.initials: DS
authors.lastname: Sheps
authors.forename: Viola
authors.initials: V
authors.lastname: Vaccarino
authors.forename: Arshed A
authors.initials: AA
authors.lastname: Quyyumi
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000453:epidemiology; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000401:mortality; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D012107:Research Design; D013315:Stress, Psychological; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods