HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Schöder, H. Articles by Czernin, J. Search for Related Content PubMed PubMed Citation Articles by Schöder, H. Articles by Czernin, J.

Effect of Mental Stress on Myocardial Blood Flow and Vasomotion in Patients with Coronary Artery Disease

Department of Molecular and Medical Pharmacology, Division of Nuclear Medicine, School of Medicine, University of California, Los Angeles
Laboratory of Structural Biology and Molecular Medicine, University of California, Los Angeles, California

Correspondence: For correspondence or reprints contact: Johannes Czernin, MD, UCLA School of Medicine/CHS, Department of Molecular and Medical Pharmacology, Ahmanson Biological Imaging Clinic, 10833 Le Conte Ave., Los Angeles, CA 90095-6942.

ABSTRACT

In patients with coronary artery disease (CAD), mental stress may provoke ischemic electrocardiograph changes and abnormalities in regional and global left ventricular function. However, little is known about the underlying myocardial blood flow response (MBF) in these patients. Methods: We investigated the hemodynamic, neurohumoral, and myocardial blood flow responses to mental stress in 17 patients with CAD and 17 healthy volunteers of similar age. Mental stress was induced by asking individuals to solve mathematic subtractions in a progressively challenging sequence; MBF was quantified at rest and during mental stress using ¹³N ammonia PET. Results: Mental stress induced significant (P < 0.01) and comparable increases in rate-pressure product, measured in beats per minute x mm Hg, in both patients (from 7826 ± 2006 to 10586 ± 2800) and healthy volunteers (from 8227 ± 1272 to 10618 ± 2468). Comparable increases also occurred in serum epinephrine (58% in patients versus 52% in healthy volunteers) and norepinephrine (22% in patients versus 27% in healthy volunteers). Although MBF increased in patients (from 0.67 ± 0.15 to 0.77 ± 0.18 mL/min/g, P < 0.05) and healthy volunteers (from 0.73 ± 0.13 to 0.95 ± 0.22 mL/min/g, P < 0.001), the magnitude of flow increase was smaller in patients (14% ± 17%) than in healthy volunteers (29% ± 14%) (P = 0.01). The increase in MBF during mental stress correlated significantly with changes in cardiac work in healthy volunteers (r = 0.77; P < 0.001) but not in patients. Conclusion: Despite similar increases in cardiac work and comparable sympathetic stimulation in CAD patients and healthy volunteers, CAD patients exhibit an attenuated blood flow response to mental stress that may contribute to mental stress-induced ischemic episodes in daily life.

Key Words: mental stress • myocardial blood flow • PET

This article has been cited by other articles:

				S. D. Holmes, D. S. Krantz, W. J. Kop, A. Del Negro, P. Karasik, and J. S. Gottdiener Mental Stress Hemodynamic Responses and Myocardial Ischemia: Does Left Ventricular Dysfunction Alter These Relationships? Psychosom Med, July 1, 2007; 69(6): 495 - 500. [Abstract] [Full Text] [PDF]

				M. Huang, X. Pang, K. Karalis, and T. C. Theoharides Stress-induced interleukin-6 release in mice is mast cell-dependent and more pronounced in Apolipoprotein E knockout mice Cardiovasc Res, July 1, 2003; 59(1): 241 - 249. [Abstract] [Full Text] [PDF]

				P.C Strike and A Steptoe Systematic review of mental stress-induced myocardial ischaemia Eur. Heart J., April 2, 2003; 24(8): 690 - 703. [Full Text] [PDF]