- 作者：Wei Jiang ; MD? ; &dagger ; ; jiang001@mc.duke.edu ; Zainab Samad ; MD&dagger ; ; Stephen Boyle ; PhD? ; Richard C. Becker ; MD&dagger ; ; Redford Williams ; MD? ; Cynthia Kuhn ; PhD&Dagger ; ; Thomas L. Ortel ; MD ; PhD&dagger ; ; Joseph Rogers ; MD&dagger ; ; Maragatha Kuchibhatla ; PhD§ ; ; Christopher O'Connor ; MD&dagger ; ; Eric J. Velazquez ; MD&dagger ;
- 关键词：mental and exercise stress ; myocardial ischemia
- 刊名：Journal of the American College of Cardiology
- 出版年：2013
- 出版时间：19 February, 2013
- 年：2013
- 卷：61
- 期：7
- 页码：714-722
- 全文大小：851 K
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 ¡Ý8 % ; and/or 3) horizontal or downsloping ST-segment depression ¡Ý1 mm in 2 or more leads lasting for ¡Ý3 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]; )