Sex-Specific Patterns of Myocardial Ischemia During Mental and Conventional Stress

摘要 心血管疾病(CVD)仍然是老年人残疾和过早死亡的主要原因 在美国和全球，最近发现年轻女性受到心血管疾病的影响不成比例 随着心肌梗死事件的增加，人们对潜在的新疾病机制和风险产生了担忧 各种因素。心理社会应激被认为在冠心病的发病机制中发挥作用 在这一脆弱的患者群体中存在心肌梗死。与此同时，最近的研究表明， 这种压力可能与男性和女性心血管疾病的不同模式有关，因为他们可能有 心血管应激倾向的发生率和机制不同。然而，与性别相关的关键差异 在生物标志物和机制方面仍然难以捉摸。因此，识别不同模式的差异 精神和身体应激期间的心肌缺血将有助于更好地描述高危状态 有助于了解心理应激时心肌缺血的机制及其机制 与非梗阻性冠状动脉疾病的关系。在这个应用中，我们将开发和使用一种新的 算法在静息/负荷心肌灌注成像结合冠状动脉造影研究中的应用 来自心肌梗死和精神应激2(MIMS-2)数据库的结果以量化区域 心肌缺血的均质性。目标1将比较心肌缺血的模式(局灶性与弥漫性) 在男性和女性以及在精神和身体压力下。在目标2中，我们将调查 用新算法量化的弥漫性轻度心肌缺血有不良的心血管后果。 拟议的分析将为理解弥漫性心肌缺血的影响提供可信的证据。 血管节段水平的冠状动脉功能和心肌血流量及其临床意义 与心血管不良结局相关。此外，这项研究还将提供一个可用于 我们对受试者的解释提高了我们对心肌缺血易感性的理解 心肌缺血、精神应激与冠心病的关系

Abstract Cardiovascular disease (CVD) continues to be a leading cause of disability and premature mortality in the United States and globally, Recently, young women have been found to be disproportionately affected by CVD with rising incident of myocardial infarctions raising concerns for potentially novel disease mechanisms and risk factors. Psychosocial stress is believed to play a role in the pathogenesis of coronary artery disease and myocardial infarction among this vulnerable patient population. At the same time, recent studies have shown that stress might be implicated in the differential pattern of CVD among men and women as they may have different incidence and mechanisms of cardiovascular proclivity to stress. However, key sex-related differences in biomarkers and mechanisms remain elusive. Therefore, the identification of differences in the pattern of myocardial ischemia during mental and physical stress will allow for the better characterization of at-risk populations and may facilitate understanding mechanisms of myocardial ischemia during mental stress and its relation to non-obstructive coronary artery disease. In this application, we will develop and use a novel algorithm applied to rest/stress myocardial perfusion imaging studies in conjunction with coronary angiography results from the Myocardial Infarction and Mental Stress 2 (MIMS-2) database to quantify regional homogeneity of myocardial ischemia. Aim 1 will compare the pattern of myocardial ischemia (focal vs diffuse) in men and women and during mental and physical stress. In Aim 2, we will investigate the association of diffuse mild myocardial ischemia as quantified by the novel algorithm with adverse cardiovascular outcomes. The proposed analyses will provide plausible evidence to understand the effects of diffuse myocardial ischemia on coronary artery function and myocardial blood flow at the levels of blood vessel segments and its association with adverse cardiovascular outcomes. Additionally, this research will provide a context to use in our interpretations of subjects improve our understanding of susceptibility to myocardial ischemia and the relationship between myocardial ischemia, mental stress and coronary artery disease.