The Mental Stress Ischemia Prognosis Study: Objectives, Study Design, and Prevalence of Inducible Ischemia
The Mental Stress Ischemia Prognosis Study: Objectives, Study Design, and Prevalence of Inducible Ischemia
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DOI：
10.1097/psy.0000000000000442
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发表时间：
2017-04-01
影响因子：
3.3
通讯作者：
Quyyumi, Arshed A.
中科院分区：
文献类型：
--
作者：
Hammadah, Muhammad;Al Mheid, Ibhar;Quyyumi, Arshed A.
目的：精神应激诱发的心肌缺血（MSIMI）是冠状动脉疾病（CAD）患者的常见现象，但其预后意义及其潜在的病理生理学的当代研究是limited.Methods：我们前瞻性地招募确诊的CAD患者在精神应激缺血预后研究（MIPS）2011年至2014年。所有患者均进行了精神压力测试，使用标准化的公开演讲任务，并通过Tc-99 m-sestamibi心肌灌注显像检测缺血。患者还进行了常规的心肌缺血负荷试验（CSIMI），使用运动或药物负荷试验。此外，手指微血管流量，内皮功能，动脉硬度，血液样本收集之前，期间和之后的精神压力。两年的不良临床结局正在评估。结果：六百九十五名患者完成了基线登记的MIPS。他们的平均（标准差）年龄为62.9（9.1）岁，72%为男性，30%为非洲裔美国人，32%有心肌梗死病史。MSIMI和CSIMI的患病率分别为16.1%和34.7%。共有151名患者（22.9%）仅患有CSIMI，28名患者（4.2%）仅患有MSIMI，78名患者（11.8%）同时患有MSIMI和CSIMI。与无诱发性缺血的患者相比，有缺血的患者射血分数较低，既往冠状动脉旁路移植术的患病率较高（p <0.050）。阻塞性CAD的患病率在MSIMI和非MSIMI患者之间无统计学差异（p = .426）;相反，CSIMI患者的患病率较高（p < .001）。结论：MIPS数据将为评估MSIMI的预后意义和潜在机制提供有用的信息。
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-99m-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 ofMSIMI 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: TheMIPS data will provide useful information to assess the prognostic significance and underlying mechanisms of MSIMI.