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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: American Heart Journal
April 1, 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 10 μM (6.95[5.54] vs. -14.23[8.75].; P = 0.045), epinephrine 10 μM (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

American Heart Journal

DOI

EISSN

1097-6744

ISSN

0002-8703

Publication Date

April 1, 2015

Volume

169

Issue

4

Start / End Page

496 / 507.e1

Related Subject Headings

  • Cardiovascular System & Hematology
  • 3201 Cardiovascular medicine and haematology
  • 1117 Public Health and Health Services
  • 1102 Cardiorespiratory Medicine and Haematology
 

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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. American Heart Journal, 169(4), 496-507.e1. https://doi.org/10.1016/j.ahj.2014.12.002
Jiang, W., S. H. Boyle, T. L. Ortel, Z. Samad, E. J. Velazquez, R. W. Harrison, J. Wilson, et al. “Platelet aggregation and mental stress induced myocardial ischemia: Results from the Responses of Myocardial Ischemia to Escitalopram Treatment (REMIT) study.” American Heart Journal 169, no. 4 (April 1, 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. American Heart Journal. 2015 Apr 1;169(4):496-507.e1.
Jiang, W., et al. “Platelet aggregation and mental stress induced myocardial ischemia: Results from the Responses of Myocardial Ischemia to Escitalopram Treatment (REMIT) study.” American Heart Journal, vol. 169, no. 4, Apr. 2015, pp. 496-507.e1. Scopus, 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. American Heart Journal. 2015 Apr 1;169(4):496-507.e1.
Journal cover image

Published In

American Heart Journal

DOI

EISSN

1097-6744

ISSN

0002-8703

Publication Date

April 1, 2015

Volume

169

Issue

4

Start / End Page

496 / 507.e1

Related Subject Headings

  • Cardiovascular System & Hematology
  • 3201 Cardiovascular medicine and haematology
  • 1117 Public Health and Health Services
  • 1102 Cardiorespiratory Medicine and Haematology