Mental Stress-Induced Myocardial Ischemia.

Mental Stress-Induced Myocardial Ischemia.
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DOI:
10.1007/s11886-022-01821-2
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发表时间:
2022-12
影响因子:
3.7
通讯作者:
Vaccarino, Viola
Vaccarino, Viola
中科院分区:
医学3区
文献类型:
--
作者:
Mehta, Puja K.;Sharma, Ashish;Bremner, J. Douglas;Vaccarino, Viola

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总结精神应激诱发的心肌缺血(MSIMI)的最新证据、其机制和临床意义。 MSIMI 可发生在心脏负荷测试正常的患者中,与冠状动脉疾病 (CAD) 的严重程度仅微弱相关,并且通常是无症状的。在患有 CAD 的患者中,与没有 MSIMI 的患者相比,MSIMI 与主要不良心血管事件的风险增加一倍相关。某些群体,例如患有心肌梗塞的年轻女性和患有心理合并症的女性,更容易受到 MSIMI 的影响。异常的微血管反应性和炎症是 MSIMI 的相关机制。调节自主神经对情绪压力和恐惧反应的区域的大脑活动增加与 MSIMI 相关。 MSIMI 对 CAD 患者的预后具有重要意义。压力作为心脏病护理中的危险因素不能再被忽视。需要进行临床试验来测试针对 MSIMI 的有效策略。
To summarize recent evidence on mental stress-induced myocardial ischemia (MSIMI), its mechanisms, and clinical significance. MSIMI can occur in patients with normal cardiac stress testing, is only weakly related to severity of coronary artery disease (CAD), and it is often silent. Among patients with CAD, MSIMI is associated with a twofold increased risk of major adverse cardiovascular events compared to those who do not have MSIMI. Certain groups such as young women with myocardial infarction and those with psychological comorbidities are more susceptible to MSIMI. Abnormal microvascular vasoreactivity and inflammation are implicated mechanisms in MSIMI. Increased brain activity in regions that modulate autonomic reactivity to emotional stress and fear is associated with MSIMI. MSIMI has important prognostic implications in patients with CAD. Stress can no longer be ignored as a risk factor in cardiology care. Clinical trials testing effective strategies to target MSIMI are needed.
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