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Platelet aggregation and mental stress induced myocardial ischemia: Results from the Responses of Myocardial Ischemia to Escitalopram Treatment (REMIT) study.

Publication ,  Journal Article
Jiang, W; Boyle, SH; Ortel, TL; Samad, Z; Velazquez, EJ; Harrison, RW; Wilson, J; Kuhn, C; Williams, RB; O'Connor, CM; Becker, RC
Published in: Am Heart J
April 2015

BACKGROUND: Mental stress-induced myocardial ischemia (MSIMI) is common in patients with ischemic heart disease (IHD) and associated with a poorer cardiovascular prognosis. Platelet hyperactivity is an important factor in acute coronary syndrome. This study examined associations between MSIMI and resting and mental stress-induced platelet activity. METHODS: Eligible patients with clinically stable IHD underwent a battery of 3 mental stress tests during the recruitment phase of REMIT study. MSIMI was assessed by echocardiography and electrocardiography. Ex vivo platelet aggregation in response to ADP, epinephrine, collagen, serotonin, and combinations of serotonin plus ADP, epinephrine, and collagen were evaluated as was platelet serotonin transporter expression. RESULTS: Of the 270 participants who completed mental stress testing, and had both resting and post-stress platelet aggregation evaluation , 43.33% (n=117) met criteria for MSIMI and 18.15% (n=49) had normal left ventricular response to stress (NLVR). The MSIMI group, relative to the NLVR groups, demonstrated heightened mental stress-induced aggregation responses, as measured by area under the curve, to collagen 10μM (6.95[5.54] vs. -14.23[8.75].; P=0.045), epinephrine 10μM (12.84[4.84] vs. -6.40[7.61].; P=0.037) and to serotonin 10 μM plus ADP 1 μM (6.64[5.29] vs. -27.34[8.34]; P<.001). The resting platelet aggregation and serotonin transporter expression, however, were not different between the two groups. CONCLUSIONS: These findings suggest that the dynamic change of platelet aggregation caused by mental stress may underlie MSIMI. While the importance of these findings requires additional investigation, they raise concern given the recognized relationship between mental stress-induced platelet hyperactivity and cardiovascular events in patients with IHD.

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Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

April 2015

Volume

169

Issue

4

Start / End Page

496 / 507.e1

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Stress, Psychological
  • Selective Serotonin Reuptake Inhibitors
  • ROC Curve
  • Platelet Aggregation
  • Myocardial Ischemia
  • Middle Aged
  • Male
  • Humans
  • Female
 

Citation

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Jiang, W., Boyle, S. H., Ortel, T. L., Samad, Z., Velazquez, E. J., Harrison, R. W., … Becker, R. C. (2015). Platelet aggregation and mental stress induced myocardial ischemia: Results from the Responses of Myocardial Ischemia to Escitalopram Treatment (REMIT) study. Am Heart J, 169(4), 496-507.e1. https://doi.org/10.1016/j.ahj.2014.12.002
Jiang, Wei, Stephen H. Boyle, Thomas L. Ortel, Zainab Samad, Eric J. Velazquez, Robert W. Harrison, Jennifer Wilson, et al. “Platelet aggregation and mental stress induced myocardial ischemia: Results from the Responses of Myocardial Ischemia to Escitalopram Treatment (REMIT) study.Am Heart J 169, no. 4 (April 2015): 496-507.e1. https://doi.org/10.1016/j.ahj.2014.12.002.
Jiang W, Boyle SH, Ortel TL, Samad Z, Velazquez EJ, Harrison RW, et al. Platelet aggregation and mental stress induced myocardial ischemia: Results from the Responses of Myocardial Ischemia to Escitalopram Treatment (REMIT) study. Am Heart J. 2015 Apr;169(4):496-507.e1.
Jiang, Wei, et al. “Platelet aggregation and mental stress induced myocardial ischemia: Results from the Responses of Myocardial Ischemia to Escitalopram Treatment (REMIT) study.Am Heart J, vol. 169, no. 4, Apr. 2015, pp. 496-507.e1. Pubmed, doi:10.1016/j.ahj.2014.12.002.
Jiang W, Boyle SH, Ortel TL, Samad Z, Velazquez EJ, Harrison RW, Wilson J, Kuhn C, Williams RB, O’Connor CM, Becker RC. Platelet aggregation and mental stress induced myocardial ischemia: Results from the Responses of Myocardial Ischemia to Escitalopram Treatment (REMIT) study. Am Heart J. 2015 Apr;169(4):496-507.e1.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

April 2015

Volume

169

Issue

4

Start / End Page

496 / 507.e1

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Stress, Psychological
  • Selective Serotonin Reuptake Inhibitors
  • ROC Curve
  • Platelet Aggregation
  • Myocardial Ischemia
  • Middle Aged
  • Male
  • Humans
  • Female