Mental stress-induced left ventricular dysfunction and adverse outcome in ischemic heart disease patients

Autor: Jennifer L. Wilson, Michael A. Babyak, Cynthia M. Kuhn, Julia L. Sun, Christopher M. O'Connor, Thomas L. Ortel, Zainab Samad, Wei Jiang, Redford B. Williams, Eric J. Velazquez, Richard C. Becker, Joseph G. Rogers, Stephen H. Boyle
Rok vydání: 2017
Předmět:
Male
medicine.medical_specialty
Time Factors
Epidemiology
Population
Myocardial Ischemia
Ischemia
Disease
Citalopram
030204 cardiovascular system & hematology
Risk Assessment
Disease-Free Survival
Ventricular Function
Left
Article
Ventricular Dysfunction
Left
03 medical and health sciences
0302 clinical medicine
Risk Factors
Internal medicine
medicine
Clinical endpoint
Humans
Escitalopram
030212 general & internal medicine
education
Aged
Proportional Hazards Models
education.field_of_study
Ejection fraction
Surrogate endpoint
business.industry
Stroke Volume
Middle Aged
medicine.disease
Mental Health
Treatment Outcome
Heart failure
Multivariate Analysis
Cardiology
Female
Medical emergency
Cardiology and Cardiovascular Medicine
business
Selective Serotonin Reuptake Inhibitors
Stress
Psychological
medicine.drug
Zdroj: European Journal of Preventive Cardiology. 24:591-599
ISSN: 2047-4881
2047-4873
Popis: 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.
Databáze: OpenAIRE
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