title: Mental stress-induced left ventricular dysfunction and adverse outcome in ischemic heart disease patients.
abstract: Aims Mental stress-induced myocardial ischemia (MSIMI) occurs in up to 70% of patients with clinically stable ischemic heart disease and is associated with increased risk of adverse prognosis. We aimed to examine the prognostic value of indices of MSIMI and exercise stress-induced myocardial ischemia (ESIMI) in a population of ischemic heart disease patients that was not confined by having a recent positive physical stress test. Methods and results The Responses of Mental Stress Induced Myocardial Ischemia to Escitalopram Treatment (REMIT) study enrolled 310 subjects who underwent mental and exercise stress testing and were followed annually for a median of four years. Study endpoints included time to first and total rate of major adverse cardiovascular events, defined as all-cause mortality and hospitalizations for cardiovascular causes. Cox and negative binomial regression adjusting for age, sex, resting left ventricular ejection fraction, and heart failure status were used to examine associations of indices of MSIMI and ESIMI with study endpoints. The continuous variable of mental stress-induced left ventricular ejection fraction change was significantly associated with both endpoints (all p values < 0.05). For every reduction of 5% in left ventricular ejection fraction induced by mental stress, patients had a 5% increase in the probability of a major adverse cardiovascular event at the median follow-up time and a 20% increase in the number of major adverse cardiovascular events endured over the follow-up period of six years. Indices of ESIMI did not predict endpoints ( ps > 0.05). Conclusion In patients with stable ischemic heart disease, mental, but not exercise, stress-induced left ventricular ejection fraction change significantly predicts risk of future adverse cardiovascular events.
authors.affiliation: 1 Department of Medicine, University of Chicago Medical Center, USA.
authors.forename: Julia L
authors.initials: JL
authors.lastname: Sun
authors.affiliation: 2 Psychiatry and Behavioral Sciences, Duke University Medical Center, USA.
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Boyle
authors.affiliation: 3 Department of Medicine, Duke University Medical Center, USA.
authors.forename: Zainab
authors.initials: Z
authors.lastname: Samad
authors.affiliation: 2 Psychiatry and Behavioral Sciences, Duke University Medical Center, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Babyak
authors.affiliation: 2 Psychiatry and Behavioral Sciences, Duke University Medical Center, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Wilson
authors.affiliation: 4 Pharmacology and Cancer Biology, Duke University Medical Center, USA.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Kuhn
authors.affiliation: 5 Department of Medicine, University of Cincinnati Medical Center, USA.
authors.forename: Richard C
authors.initials: RC
authors.lastname: Becker
authors.affiliation: 3 Department of Medicine, Duke University Medical Center, USA.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Ortel
authors.affiliation: 2 Psychiatry and Behavioral Sciences, Duke University Medical Center, USA.
authors.forename: Redford B
authors.initials: RB
authors.lastname: Williams
authors.affiliation: 3 Department of Medicine, Duke University Medical Center, USA.|6 Duke Clinical Research Institute, USA.
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Rogers
authors.affiliation: 3 Department of Medicine, Duke University Medical Center, USA.|6 Duke Clinical Research Institute, USA.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
authors.affiliation: 3 Department of Medicine, Duke University Medical Center, USA.|6 Duke Clinical Research Institute, USA.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Velazquez
authors.affiliation: 2 Psychiatry and Behavioral Sciences, Duke University Medical Center, USA.|3 Department of Medicine, Duke University Medical Center, USA.
authors.forename: Wei
authors.initials: W
authors.lastname: Jiang
mesh_terms: D000368:Aged; D015283:Citalopram / Q000627:therapeutic use; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D013315:Stress, Psychological / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D016277:Ventricular Function, Left
chemical_list: D015283:Citalopram; D017367:Selective Serotonin Reuptake Inhibitors
keywords: Mental stress; ejection fraction; exercise stress