Vascular Responses During Mental Stress

摘要 以前的研究表明，精神压力引起的缺血是典型的沉默，可能占高达 75%的总缺血负荷在正常日常生活中经历，并且与更差的长期 结果。然而，冠状动脉和外周血管的变化，伴随着精神压力的患者， 在精神应激期间伴有和不伴有缺血的冠状动脉疾病（CAD）患者尚未进行研究， 并且可能对理解导致风险增加的潜在机制至关重要 在这些患者中。该项目的总体目标是研究CAD受试者在精神应激期间（a）冠状动脉和/或（B）外周血管系统和（c）促炎反应的异常血管反应性是否会导致心肌缺血。这将：1）提供对CAD患者中伴随精神应激的潜在冠状动脉和外周血管改变和全身炎症变化的机制理解，以及它们如何促成心肌缺血; 2）在SPECT期间识别精神应激诱导的缺血（MSI）的外周血管和/或炎症预测因子;和3）确定通过反复暴露于日常生活心理应激源而对心理应激测试具有更异常反应的受试者是否在随访期间发展更大的血管功能障碍和更严重的全身炎症。我们的研究结果将有助于开发1）治疗MSI的特定治疗方法，该方法与不良长期结局相关，以及2）新的治疗模型。 基于精神压力的压力测试用于预后评估 通常通过运动或药理学测试来评估。

Abstract Previous studies show that mental stress-induced ischemia is characteristically silent, may account for up to 75% of the total ischemic burden experienced during normal daily life, and is associated with worse long term outcome. However, the coronary and peripheral vascular changes that accompany mental stress in patients with coronary artery disease (CAD) with and without ischemia during mental stress have not been investigated, and are likely to be crucial in providing understanding of the underiying mechanisms that lead to increased risk in these patients. The overall goal of the project is to investigate whether abnormal vascular reactivity of (a) the coronary and/or (b) peripheral vasculature and (c) a pro-inflammatory response contribute to myocardial ischemia during mental stress in subjects with CAD. This will: 1) provide a mechanistic understanding of the underiying coronary and peripheral vascular alterations and systemic inflammatory changes that accompany mental stress in patients with CAD, and how they contribute to myocardial ischemia; 2) identify peripheral vascular and/or inflammatory predictors of mental stress-induced ischemia (MSI) during SPECT; and 3) determine whether subjects who have a more abnormal reaction to mental stress testing, by repeated exposure to daily life psychologic stressors, develop greater vascular dysfunction and more severe systemic inflammation during follow-up. The results of our studies will assist development of 1) specific therapeutic approaches for treatment of MSI that is associated with adverse long term outcome, and 2) new model of mental stress-based stress testing for prognostic evaluation conventionally evaluated by exercise or pharmacologic tests.