Exaggerated reactivity to mental stress is associated with exercise-induced myocardial ischemia in an asymptomatic high-risk population.
Exaggerated reactivity to mental stress is associated with exercise-induced myocardial ischemia in an asymptomatic high-risk population.
复制标题
在无症状的高危人群中，对精神压力的过度反应与运动引起的心肌缺血有关。
DOI：
10.1161/01.cir.96.12.4246
复制
发表时间：
1997
期刊：
影响因子：
37.8
通讯作者：
Becker,DM
中科院分区：
文献类型：
--
作者：
Kral,BG;Becker,LC;Blumenthal,RS;Aversano,T;Fleisher,LA;Yook,RM;Becker,DM
BackgroundThis study was done to determine whether cardiovascular reactivity to mental stress is associated with exercising induced occult ischemia in a asymptomatic population at high risk for premature coronary heart disease（CHD）.Methods and Results152 siblings of persons with premature CHD undergoing mental stress testing.还进行了运动铊断层扫描和24小时霍尔特心电图监测。在两种应激过程中监测血流动力学变化。对运动性缺血阳性的患者进行心导管检查。在精神压力期间，与没有运动诱发缺血的同胞相比，运动心电图和/或铊扫描异常的同胞（n=15）在收缩压（SBP，P=.0004）和舒张压（DBP，P=.05）方面有更大的最大增加，并且在霍尔特监测记录分析的标准化低频域中有更大的心率变异性。冠状动脉造影证实，85%的同胞与运动诱导的缺血冠状动脉粥样硬化。回归分析表明，运动时隐匿性缺血是精神应激时SBP和DBP最大变化的一个强有力的独立预测因子。多变量logistic模型表明，运动引起的隐匿性缺血的兄弟姐妹是21倍更有可能是“热”的反应（在收缩压和舒张压的变化的前四分位数）在精神stress. ConclusionsA夸张的心血管反应的精神stress.A与运动引起的心肌缺血的人与临床前冠心病。
BackgroundThis study was done to determine whether cardiovascular reactivity to mental stress is associated with exercise-induced occult ischemia in an asymptomatic population at high risk for premature coronary heart disease (CHD).Methods and ResultsOne hundred fifty-two siblings of persons with premature CHD underwent mental stress testing. Exercise thallium tomography and 24-hour Holter monitoring were also performed. Hemodynamic changes were monitored during both stressors. Siblings positive for exercise-induced ischemia were offered cardiac catheterization. During mental stress, siblings with an abnormal exercise ECG and/or thallium scan (n=15) had greater maximal increases in systolic blood pressure (SBP,P=.0004) and diastolic blood pressure (DBP,P=.05) and had greater heart rate variability in the normalized low frequency domain of an analysis of Holter monitor recordings, compared with siblings without exercise-induced ischemia. Coronary arteriography confirmed coronary atherosclerosis in 85% of siblings with exercise-induced ischemia. Regression analyses showed that occult ischemia during exercise was a strong independent predictor of maximal change in SBP and DBP during mental stress. A multivariate logistic model demonstrated that siblings with exercise-induced occult ischemia were 21 times more likely to be “hot” responders (top quartile of change in SBP and DBP) during mental stress.ConclusionsAn exaggerated cardiovascular response to mental stress is associated with exercise-induced myocardial ischemia in persons with preclinical coronary heart disease.