Hemodynamic, catecholamine, vasomotor and vascular responses: Determinants of myocardial ischemia during mental stress
Hemodynamic, catecholamine, vasomotor and vascular responses: Determinants of myocardial ischemia during mental stress
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DOI：
10.1016/j.ijcard.2017.05.093
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发表时间：
2017-09-15
影响因子：
3.5
通讯作者：
Quyyumi, Arshed A.
中科院分区：
文献类型：
--
作者：
Hammadah, Muhammad;Alkhoder, Ayman;Quyyumi, Arshed A.
目的：冠心病(CAD)患者心理应激诱发心肌缺血(MSIMI)与心血管不良结局相关。目的评价心肌梗死的血流动力学、神经激素、血管内皮、血管运动和血管预测因子。方法与结果：我们对660例稳定型冠心病患者进行了静息、精神(言语任务)和常规(运动/药物)负荷的99mTc心肌灌注显像。测定静息状态和心理应激30min后血管内膜依赖性血流介导的扩张(FMD)、微血管反应性[反应性充血指数(RHI)]和动脉僵硬[脉搏波速度(PWV)]。采用外周动脉血压计(PAT)评估精神应激时的指端微血管运动反应。共有106名患者(16.1%)患有MSIMI。精神应激伴随心率-血压乘积(心率×收缩压)、肾上腺素水平和PWV显著增加，而FMD和表示微血管收缩的PAT比率显著降低。与非MSIMI患者相比，MSIMI患者有更高的血流动力学和数字血管收缩反应(P<；0.05)，但在肾上腺素、内皮或大血管反应方面没有差异。仅在常规应激期间存在缺血(OR为7.1，95%CI为4.2，11.9)、高血流动力学反应(RPP反应OR=1.8，95%CI为1.1，2.8)和高指端血管收缩(OR为Pat Ratio<；vs>；ROC截断值为2.1，95%可信区间为1.3，3.3)是MSIMI的独立预测因素。结论：常规负荷试验中的缺血和对心理应激的血流动力学和血管收缩反应有助于预测冠心病患者发生MSIMI的风险。(C)2017爱思唯尔B.V.保留所有权利。
Aims: Mental stress-induced myocardial ischemia (MSIMI) in patients with coronary artery disease (CAD) is associatedwith adverse cardiovascular outcomes. Weaimto assess hemodynamic, neuro-hormonal, endothelial, vasomotor and vascular predictors of MSIMI.Methods and results: We subjected 660 patients with stable CAD to 99mTc sestamibimyocardial perfusion imaging at rest, with mental (speech task) and with conventional (exercise/pharmacological) stress. Endotheliumdependent flow-mediated dilation (FMD), microvascular reactivity [reactive hyperemia index (RHI)] and arterial stiffness [pulse wave velocity (PWV)] were measured at rest and 30-min after mental stress. The digital microvascular vasomotor response during mental stress was assessed using peripheral arterial tonometry (PAT). A total of 106(16.1%) patients had MSIMI. Mental stress was accompanied by significant increases in ratepressure-product (heart rate x systolic blood pressure; RPP), epinephrine levels and PWV, and significant decreases in FMD and PAT ratio denotingmicrovascular constriction. In comparison to those with noMSIMI, patients with MSIMI had higher hemodynamic and digital vasoconstrictive responses (p < 0.05 for both), but did not differ in epinephrine, endothelial ormacrovascular responses. Only presence of ischemia during conventional stress (OR of 7.1, 95% CI of 4.2, 11.9), high hemodynamic response (OR for RPP response >= vs < ROC cutoff of 1.8, 95% CI of 1.1, 2.8), and high digital vasoconstriction (OR for PAT ratio < vs >= ROC cutoff of 2.1, 95% CI of 1.3, 3.3) were independent predictors of MSIMI.Conclusion: Ischemia during conventional stress testing and hemodynamic and vasoconstrictive responses to mental stress can help predict subjects with CAD at greater risk of developing MSIMI. (C) 2017 Elsevier B. V. All rights reserved.