MENTAL STRESS AND THE INDUCTION OF SILENT MYOCARDIAL ISCHEMIA IN PATIENTS WITH CORONARY-ARTERY DISEASE
MENTAL STRESS AND THE INDUCTION OF SILENT MYOCARDIAL ISCHEMIA IN PATIENTS WITH CORONARY-ARTERY DISEASE
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DOI：
10.1056/nejm198804213181601
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发表时间：
1988-04-21
影响因子：
158.5
通讯作者：
BERMAN, DS
中科院分区：
文献类型：
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作者：
ROZANSKI, A;BAIREY, CN;BERMAN, DS
为了评估急性精神应激与心肌缺血之间的因果关系，我们评估了选定患者在一系列精神任务（算术、Stroop色词任务、模拟公开演讲和阅读）中的心脏功能，并将其反应与运动引起的反应进行比较。对39例冠心病患者和12例对照者进行了放射性核素心室造影研究。在患有冠状动脉疾病的患者中，23名（59%）在精神压力期间有室壁运动异常，14名（36%）射血分数下降超过5个百分点。在23例室壁运动异常的患者中，平均负荷引起的缺血在心脏病学上是“沉默的”（83%），并且发生在比运动引起的缺血更低的心率下（P < 0.05）。相反，我们观察到在由精神压力引起的缺血和由运动引起的缺血期间动脉压的升高相当。与引起心理应激的认知任务相比，个人相关的、情绪激动的说话任务诱发的局部室壁运动异常更频繁、更严重（P < 0.05）。由说话任务引起的心功能不全的程度与由运动引起的相似。在冠心病患者中，个人相关的精神压力可能是心肌缺血的重要促发因素，通常是无症状的。进一步研究精神应激引起心肌缺血的病理生理机制对治疗短暂性心肌缺血具有重要意义。
To assess the causal relation between acute mental stress and myocardial ischemia, we evaluated cardiac function in selected patients during a series of mental tasks (arithmetic, the Stroop color-word task, simulated public speaking, and reading) and compared the responses with those induced by exercise. Thirty-nine patients with coronary artery disease and 12 controls were studied by radionuclide ventriculography. Of the patients with coronary artery disease, 23 (59 percent) had wall-motion abnormalities during periods of mental stress and 14 (36 percent) had a fall in ejection fraction of more than 5 percentage points. Ischemia induced by meantal stress was symptomatically "silent" in 19 of the 23 patients with wall-motion abnormalities (83 percent) and occurred at lower heart rates than exercise-induced ischemia (P < 0.05). In contrast, we observed comparable elevations in arterial pressure during ischemia induced by mental stress and ischemia induced by exercise. A personally relevant, emotionally arousing speaking task induced more frequent and greater regional wall-motion abnormalities than did less specific cognitive tasks causing mental stress (P < 0.05). The magnitude of cardiac dysfunction induced by the speaking task was similar to that induced by exericse. Personally relevant mental stess may be an important precipitant of myocardial ischemia-often silent-in patients with coronary artery disease. Further examination of the pathophysiologic mechanisms responsible for myocardial ischemia induced by mental stress could have importnat implications for the treatment of transient myocardial ischemia.