Brain Correlates of Mental Stress-Induced Myocardial Ischemia.
Brain Correlates of Mental Stress-Induced Myocardial Ischemia.
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DOI：
10.1097/psy.0000000000000597
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发表时间：
2018
影响因子：
3.3
通讯作者：
Vaccarino V
中科院分区：
文献类型：
--
作者：
Bremner JD;Campanella C;Khan Z;Shah M;Hammadah M;Wilmot K;Al Mheid I;Lima BB;Garcia EV;Nye J;Ward L;Kutner MH;Raggi P;Pearce BD;Shah AJ;Quyyumi AA;Vaccarino V
冠状动脉疾病（CAD）是发病和死亡的主要原因，尽管我们对这种疾病的理解取得了重要进展，但其潜在机制仍在研究中。最近，人们越来越关注情绪压力等行为因素对 CAD 风险的影响。涉及记忆和应激反应的大脑区域，包括内侧前额叶皮层、岛叶和顶叶皮层，也有对外周心血管系统的输出。本研究的目的是评估精神压力对 CAD 患者大脑和心脏功能的影响。 CAD 患者 (N=170) 在休息时和公共演讲精神压力任务期间使用 [Tc-99m] 赛他米比单光子发射断层扫描 (SPECT) 进行心脏成像。另一天，他们在精神压力（算术和公开演讲）和控制条件下使用[O-15]水正电子发射断层扫描（PET）对大脑进行了成像。精神应激诱发的心肌缺血 (MSI) 患者的前扣带回、额下回和顶叶皮质的应激活性增加 (p<0.005)。在算术压力和公开演讲压力中都可以看到这一点。算术压力还与左侧岛叶激活相关，而公开演讲则与右侧中央前/后回和颞中回激活相关（p<0.005）。这些发现表明，精神应激引起的心肌缺血与涉及心血管系统应激反应和自主调节的大脑区域的激活有关。大脑对压力反应的改变可能代表了一种机制，通过这种机制，压力会导致 CAD 相关发病率和死亡率的风险增加。
Coronary artery disease (CAD) is a major cause of morbidity and mortality, and despite important advances in our understanding of this disorder, the underlying mechanisms remain under investigation. Recently, increased attention has been placed to the role of behavioral factors like emotional stress on CAD risk. Brain areas involved in memory and the stress response, including medial prefrontal cortex, insula and parietal cortex, also have outputs to the peripheral cardiovascular system. The purpose of this study was to assess the effects of mental stress on brain and cardiac function in patients with CAD. CAD patients (N=170) underwent cardiac imaging with [Tc-99m] sestamibi single photon emission tomography (SPECT) at rest and during a public speaking mental stress task. On another day they underwent imaging of the brain with [O-15] water positron emission tomography (PET) during mental stress (arithmetic and public speaking) and control conditions. Patients with mental stress-induced myocardial ischemia (MSI) showed increased activation with stress in anterior cingulate, inferior frontal gyrus, and parietal cortex (p<0.005). This was seen with both arithmetic stress and public speaking stress. Arithmetic stress was additionally associated with left insula activation, and public speaking with right pre/post-central gyrus and middle temporal gyrus activation (p<0.005). These findings suggest that mental stress-induced myocardial ischemia is associated with activation in brain areas involved in the stress response and autonomic regulation of the cardiovascular system. Altered brain reactivity to stress could possibly represent a mechanism through which stress leads to increased risk of CAD-related morbidity and mortality.