The Mental Stress Ischemia Prognosis Study: Objectives, Study Design, and Prevalence of Inducible Ischemia

Autor: Paolo Raggi, Muhammad Hammadah, Ibhar Al Mheid, Michael Kutner, Ronnie Ramadan, Kobina A. Wilmot, David S. Sheps, Arshed A. Quyyumi, J. Douglas Bremner, Brad Pearce, Yan V. Sun, Viola Vaccarino, Fabio Esteves, Amit J. Shah, Ernest Garcia
Rok vydání: 2017
Předmět:
Male
Research design
medicine.medical_specialty
Myocardial ischemia
Myocardial Ischemia
Ischemia
Coronary Artery Disease
030204 cardiovascular system & hematology
Article
Coronary artery disease
03 medical and health sciences
Myocardial perfusion imaging
0302 clinical medicine
Predictive Value of Tests
Internal medicine
Outcome Assessment
Health Care
Prevalence
medicine
Humans
cardiovascular diseases
Applied Psychology
Aged
Tomography
Emission-Computed
Single-Photon
medicine.diagnostic_test
business.industry
Myocardial Perfusion Imaging
Middle Aged
Prognosis
medicine.disease
Pathophysiology
Surgery
Psychiatry and Mental health
Research Design
Predictive value of tests
Exercise Test
Cardiology
Inducible ischemia
Female
business
Stress
Psychological
030217 neurology & neurosurgery
Follow-Up Studies
Zdroj: Psychosomatic Medicine. 79:311-317
ISSN: 1534-7796
0033-3174
Popis: 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.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.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).The MIPS data will provide useful information to assess the prognostic significance and underlying mechanisms of MSIMI.
Databáze: OpenAIRE
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