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Mental stress-induced left ventricular dysfunction and adverse outcome in ischemic heart disease patients.

Publication ,  Journal Article
Sun, JL; Boyle, SH; Samad, Z; Babyak, MA; Wilson, JL; Kuhn, C; Becker, RC; Ortel, TL; Williams, RB; Rogers, JG; O'Connor, CM; Velazquez, EJ; Jiang, W
Published in: Eur J Prev Cardiol
April 2017

Aims Mental stress-induced myocardial ischemia (MSIMI) occurs in up to 70% of patients with clinically stable ischemic heart disease and is associated with increased risk of adverse prognosis. We aimed to examine the prognostic value of indices of MSIMI and exercise stress-induced myocardial ischemia (ESIMI) in a population of ischemic heart disease patients that was not confined by having a recent positive physical stress test. Methods and results The Responses of Mental Stress Induced Myocardial Ischemia to Escitalopram Treatment (REMIT) study enrolled 310 subjects who underwent mental and exercise stress testing and were followed annually for a median of four years. Study endpoints included time to first and total rate of major adverse cardiovascular events, defined as all-cause mortality and hospitalizations for cardiovascular causes. Cox and negative binomial regression adjusting for age, sex, resting left ventricular ejection fraction, and heart failure status were used to examine associations of indices of MSIMI and ESIMI with study endpoints. The continuous variable of mental stress-induced left ventricular ejection fraction change was significantly associated with both endpoints (all p values < 0.05). For every reduction of 5% in left ventricular ejection fraction induced by mental stress, patients had a 5% increase in the probability of a major adverse cardiovascular event at the median follow-up time and a 20% increase in the number of major adverse cardiovascular events endured over the follow-up period of six years. Indices of ESIMI did not predict endpoints ( ps > 0.05). Conclusion In patients with stable ischemic heart disease, mental, but not exercise, stress-induced left ventricular ejection fraction change significantly predicts risk of future adverse cardiovascular events.

Duke Scholars

Published In

Eur J Prev Cardiol

DOI

EISSN

2047-4881

Publication Date

April 2017

Volume

24

Issue

6

Start / End Page

591 / 599

Location

England

Related Subject Headings

  • Ventricular Function, Left
  • Ventricular Dysfunction, Left
  • Treatment Outcome
  • Time Factors
  • Stroke Volume
  • Stress, Psychological
  • Selective Serotonin Reuptake Inhibitors
  • Risk Factors
  • Risk Assessment
  • Proportional Hazards Models
 

Citation

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Sun, J. L., Boyle, S. H., Samad, Z., Babyak, M. A., Wilson, J. L., Kuhn, C., … Jiang, W. (2017). Mental stress-induced left ventricular dysfunction and adverse outcome in ischemic heart disease patients. Eur J Prev Cardiol, 24(6), 591–599. https://doi.org/10.1177/2047487316686435
Sun, Julia L., Stephen H. Boyle, Zainab Samad, Michael A. Babyak, Jennifer L. Wilson, Cynthia Kuhn, Richard C. Becker, et al. “Mental stress-induced left ventricular dysfunction and adverse outcome in ischemic heart disease patients.Eur J Prev Cardiol 24, no. 6 (April 2017): 591–99. https://doi.org/10.1177/2047487316686435.
Sun JL, Boyle SH, Samad Z, Babyak MA, Wilson JL, Kuhn C, et al. Mental stress-induced left ventricular dysfunction and adverse outcome in ischemic heart disease patients. Eur J Prev Cardiol. 2017 Apr;24(6):591–9.
Sun, Julia L., et al. “Mental stress-induced left ventricular dysfunction and adverse outcome in ischemic heart disease patients.Eur J Prev Cardiol, vol. 24, no. 6, Apr. 2017, pp. 591–99. Pubmed, doi:10.1177/2047487316686435.
Sun JL, Boyle SH, Samad Z, Babyak MA, Wilson JL, Kuhn C, Becker RC, Ortel TL, Williams RB, Rogers JG, O’Connor CM, Velazquez EJ, Jiang W. Mental stress-induced left ventricular dysfunction and adverse outcome in ischemic heart disease patients. Eur J Prev Cardiol. 2017 Apr;24(6):591–599.
Journal cover image

Published In

Eur J Prev Cardiol

DOI

EISSN

2047-4881

Publication Date

April 2017

Volume

24

Issue

6

Start / End Page

591 / 599

Location

England

Related Subject Headings

  • Ventricular Function, Left
  • Ventricular Dysfunction, Left
  • Treatment Outcome
  • Time Factors
  • Stroke Volume
  • Stress, Psychological
  • Selective Serotonin Reuptake Inhibitors
  • Risk Factors
  • Risk Assessment
  • Proportional Hazards Models