The Mental Stress Ischemia Prognosis Study

Objectives, Study Design, and Prevalence of Inducible Ischemia

Bibliographic Data

ID19306100
AuthorsMuhammad Hammadah (0000-0002-1596-4836, Atlanta VA Medical Center), Ibhar Al Mheid, Kobina Wilmot, Ronnie Ramadan, Amit Shah (0000-0001-9099-9687), Amit J Shah, Yan Sun (0000-0001-7588-8444), Yan V Sun (0000-0002-2838-1824), Brad D Pearce (0000-0002-3259-4275), Brad Pearce, Ernest Garcia (0000-0002-9373-6839), Ernest V Garcia, Michael Kutner (0000-0002-7600-2024), J Douglas Bremner (0000-0003-1633-6433), Fabio Esteves (0000-0002-3869-5253), Paolo Raggi (0000-0002-5766-1948), David S Sheps, Viola Vaccarino (0000-0002-9054-0654), Arshed A Quyyumi (0000-0002-8166-679X, corresponding author)
Year2017
Volume79
Issue3
Pages311-317
Publication date2017-04-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenuePsychosomatic Medicine (JOURNAL)
Journal identifiersISSN: 0033-3174 • E-ISSN: 1534-7796
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/psy.0000000000000442
PMID28002382
OpenAlexW2563525854
LanguageEN
Citations received7
References cited59

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

Cardiology · Coronary artery disease · Ejection fraction · Heart failure · Ischemia · Myocardial infarction · Myocardial perfusion imaging · Stress testing (software) · Cardiac Health and Mental Health · Cardiac Imaging and Diagnostics · Internal Medicine · Medicine · Takotsubo Cardiomyopathy and Associated Phenomena

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