Peripheral Vasoconstriction During Mental Stress and Adverse Cardiovascular Outcomes in Patients With Coronary Artery Disease
| Autor: | Jeong Hwan Kim, Samaah Sullivan, J. Douglas Bremner, Laura Ward, Chang Liu, David S. Sheps, Paolo Raggi, Rami Abdulbaki, Bruno B Lima, Ayman Alkhoder, Amit J. Shah, Yan V. Sun, Viola Vaccarino, Zakaria Almuwaqqat, Yi-An Ko, Muhammad Hammadah, Arshed A. Quyyumi |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Physiology Peripheral vasoconstriction Coronary Artery Disease 030204 cardiovascular system & hematology medicine.disease_cause Article Cohort Studies Coronary artery disease 03 medical and health sciences 0302 clinical medicine Internal medicine Mental stress medicine Humans Psychological stress In patient Plethysmography Impedance Myocardial infarction Aged business.industry Middle Aged medicine.disease Vasoconstriction Cardiology Female medicine.symptom Cardiology and Cardiovascular Medicine business Cardiovascular outcomes Blood Flow Velocity Stress Psychological 030217 neurology & neurosurgery Follow-Up Studies |
| Zdroj: | Circ Res |
| ISSN: | 1524-4571 0009-7330 |
| Popis: | Rationale: Excessive vasoconstriction in response to mental stress may be a potential mechanism by which acute psychological stress leads to adverse cardiac events. Objectives: We investigated whether excessive digital vasoconstriction during acute mental stress predicts adverse cardiovascular outcomes among patients with coronary artery disease. Methods and Results: Five hundred forty-nine patients with stable coronary artery disease (age 63±9, 76% male, 29% black) underwent mental stress testing with a standardized public speaking stressor and followed prospectively for cardiovascular end points. Digital pulse wave amplitude was continuously measured using peripheral artery tonometry (PAT, Itamar Inc). Stress/rest PAT ratio (sPAT) of pulse wave amplitude during mental stress/baseline was calculated and dichotomized by the median value into low and high sPAT ratio groups. Upon 3-year follow-up, Fine and Gray’s subdistribution hazard ratios were used to examine the association between sPAT ratio and the composite end point of cardiovascular death, myocardial infarction, revascularization, and hospitalization for heart failure. The median sPAT ratio was 0.68 (interquartile range, 0.48–0.88), indicating 32% vasoconstriction with mental stress. Men were more likely to have low sPAT ratio than women (odds ratio, 1.79; P =0.007) while those on β-blockers were less likely to have low sPAT ratio (odds ratio, 0.52; P =0.003). After adjusting for demographic and cardiovascular risk factors, medications, and rate-pressure product change during mental stress, those with low sPAT ratio were at significantly higher risk of adverse outcomes (subdistribution hazard ratio, 1.77 [95% CI, 1.12–2.80]). Conclusions: Greater peripheral vasoconstriction with mental stress, denoted by a low sPAT ratio, is associated with a higher risk of adverse cardiovascular outcomes in patients with coronary artery disease. |
| Databáze: | OpenAIRE |
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