Vascular Responses During Mental Stress

摘要 以前的研究表明，精神应激诱导的缺血具有沉默的特点，可能会导致 75%的总缺血负荷是在正常的日常生活中经历的，并且与较差的长期相关 结果。然而，伴随着精神应激的患者的冠状动脉和外周血管的变化 在精神应激期间伴有和不伴有缺血的冠状动脉疾病(CAD)尚未被研究， 并可能在提供对导致风险增加的潜在机制的理解方面至关重要 在这些病人身上。该项目的总体目标是调查(A)冠状动脉和/或(B)外周血管系统的异常血管反应性和(C)促炎反应是否导致冠心病受试者在精神应激期间的心肌缺血。这将：1)从机制上了解冠心病患者心理应激引起的冠状动脉和外周血管改变和全身性炎症改变，以及它们如何导致心肌缺血；2)确定SPECT期间精神应激诱导缺血(MSI)的外周血管和/或炎症预测指标；3)确定因反复暴露于日常生活心理应激源而对心理应激测试有更异常反应的受试者，是否在随访中发展为更严重的血管功能障碍和更严重的全身性炎症。我们的研究结果将有助于开发1)与不良长期结果相关的微创感染的特定治疗方法，以及2)新的治疗模式 基于心理压力测试的预后评估 传统上通过运动或药理学测试进行评估。

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.