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Prevalence and clinical characteristics of mental stress-induced myocardial ischemia in patients with coronary heart disease.

Publication ,  Journal Article
Jiang, W; Samad, Z; Boyle, S; Becker, RC; Williams, R; Kuhn, C; Ortel, TL; Rogers, J; Kuchibhatla, M; O'Connor, C; Velazquez, EJ
Published in: J Am Coll Cardiol
February 19, 2013

OBJECTIVES: The goal of this study was to evaluate the prevalence and clinical characteristics of mental stress-induced myocardial ischemia. BACKGROUND: Mental stress-induced myocardial ischemia is prevalent and a risk factor for poor prognosis in patients with coronary heart disease, but past studies mainly studied patients with exercise-induced myocardial ischemia. METHODS: Eligible patients with clinically stable coronary heart disease, regardless of exercise stress testing status, underwent a battery of 3 mental stress tests followed by a treadmill test. Stress-induced ischemia, assessed by echocardiography and electrocardiography, was defined as: 1) development or worsening of regional wall motion abnormality; 2) left ventricular ejection fraction reduction ≥ 8%; and/or 3) horizontal or downsloping ST-segment depression ≥ 1 mm in 2 or more leads lasting for ≥ 3 consecutive beats during at least 1 mental test or during the exercise test. RESULTS: Mental stress-induced ischemia occurred in 43.45%, whereas exercise-induced ischemia occurred in 33.79% (p = 0.002) of the study population (N = 310). Women (odds ratio [OR]: 1.88), patients who were not married (OR: 1.99), and patients who lived alone (OR: 2.24) were more likely to have mental stress-induced ischemia (all p < 0.05). Multivariate analysis showed that compared with married men or men living with someone, unmarried men (OR: 2.57) and married women (OR: 3.18), or living alone (male OR: 2.25 and female OR: 2.72, respectively) had higher risk for mental stress-induced ischemia (all p < 0.05). CONCLUSIONS: Mental stress-induced ischemia is more common than exercise-induced ischemia in patients with clinically stable coronary heart disease. Women, unmarried men, and individuals living alone are at higher risk for mental stress-induced ischemia. (Responses of Myocardial Ischemia to Escitalopram Treatment [REMIT]; NCT00574847).

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Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

February 19, 2013

Volume

61

Issue

7

Start / End Page

714 / 722

Location

United States

Related Subject Headings

  • Stress, Psychological
  • Risk Factors
  • Prevalence
  • Myocardial Ischemia
  • Middle Aged
  • Male
  • Humans
  • Female
  • Exercise Test
  • Electrocardiography
 

Citation

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Jiang, W., Samad, Z., Boyle, S., Becker, R. C., Williams, R., Kuhn, C., … Velazquez, E. J. (2013). Prevalence and clinical characteristics of mental stress-induced myocardial ischemia in patients with coronary heart disease. J Am Coll Cardiol, 61(7), 714–722. https://doi.org/10.1016/j.jacc.2012.11.037
Jiang, Wei, Zainab Samad, Stephen Boyle, Richard C. Becker, Redford Williams, Cynthia Kuhn, Thomas L. Ortel, et al. “Prevalence and clinical characteristics of mental stress-induced myocardial ischemia in patients with coronary heart disease.J Am Coll Cardiol 61, no. 7 (February 19, 2013): 714–22. https://doi.org/10.1016/j.jacc.2012.11.037.
Jiang W, Samad Z, Boyle S, Becker RC, Williams R, Kuhn C, et al. Prevalence and clinical characteristics of mental stress-induced myocardial ischemia in patients with coronary heart disease. J Am Coll Cardiol. 2013 Feb 19;61(7):714–22.
Jiang, Wei, et al. “Prevalence and clinical characteristics of mental stress-induced myocardial ischemia in patients with coronary heart disease.J Am Coll Cardiol, vol. 61, no. 7, Feb. 2013, pp. 714–22. Pubmed, doi:10.1016/j.jacc.2012.11.037.
Jiang W, Samad Z, Boyle S, Becker RC, Williams R, Kuhn C, Ortel TL, Rogers J, Kuchibhatla M, O’Connor C, Velazquez EJ. Prevalence and clinical characteristics of mental stress-induced myocardial ischemia in patients with coronary heart disease. J Am Coll Cardiol. 2013 Feb 19;61(7):714–722.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

February 19, 2013

Volume

61

Issue

7

Start / End Page

714 / 722

Location

United States

Related Subject Headings

  • Stress, Psychological
  • Risk Factors
  • Prevalence
  • Myocardial Ischemia
  • Middle Aged
  • Male
  • Humans
  • Female
  • Exercise Test
  • Electrocardiography