Effects of mental stress on left ventricular and peripheral vascular performance in patients with coronary artery disease

Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut 06520, USA. DJ_Jain@quickmail.yale.edu

OBJECTIVES: We sought to investigate the mechanism of a mental stress-induced fall in left ventricular ejection fraction (LVEF) in patients with coronary artery disease. BACKGROUND: Mental stress induces a fall in LVEF in a significant proportion of patients with coronary artery disease. This is accompanied by an increase in heart rate, blood pressure and rate-pressure product. Whether the mental stress-induced fall in LVEF is due to myocardial ischemia, altered loading conditions or a combination of both is not clear. METHODS: Left ventricular (LV) function was studied noninvasively by serial equilibrium radionuclide angiocardiography and simultaneous measurement of peak power, a relatively afterload-independent index of LV contractility, in 21 patients with coronary artery disease (17 men, 4 women) and 9 normal subjects (6 men, 3 women) at baseline, during mental stress and during exercise. Peripheral vascular resistance (PVR), cardiac output (CO), arterial and end-systolic ventricular elastance (Ea, Ees,) and ventriculoarterial coupling (V/AC) were also calculated. Patients underwent two types of mental stress-mental arithmetic and anger recall-as well as symptom-limited semisupine bicycle exercise. RESULTS: Nine patients (43%) had an absolute fall in LVEF of > or = 5% (Group I) in response to at least one of the mental stressors, whereas the remaining patients did not (Group II). Group I and Group II patients were similar in terms of baseline characteristics. Both groups showed a significant but comparable increase in systolic blood pressure (15+/-7 vs. 9+/-10 mm Hg, p=0.12) and a slight increase in heart rate (7+/-4 vs. 8+/-7 beats/min, p=0.6) and a comparable increase in rate-pressure product (2.2+/-0.9 vs. 1.9+/-1.2 beats/min x mm Hg, p=0.6) with mental stress. However, PVR increased in Group I and decreased in Group II (252+/-205 vs. -42+/-230 dynes x s x cm(-5), p=0.006), and CO decreased in Group I and increased in Group II (-0.2+/-0.4 vs. 0.6+/-0.7 liters/min, p=0.02) with mental stress. There was no difference in the change in peak power (p=0.4) with mental stress. With exercise, an increase in systolic blood pressure, heart rate, rate-pressure product and CO and a fall in PVR were similar in both groups. Of the two mental stressors, anger recall resulted in a greater fall in LVEF and a greater increase in diastolic blood pressure. Exercise resulted in a fall in LVEF in 7 patients (33%). However, exercise-induced changes in LVEF and hemodynamic variables were not predictive of mental stress-induced changes in LVEF and hemodynamic variables. Conclusions. Abnormal PVR and Ea responses to mental stress and exercise are observed in patients with a mental stress-induced fall in LVEF. Peripheral vasoconstrictive responses to mental stress contribute significantly toward a mental stress-induced fall in LVEF.

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]

				B. A. Golomb, T. T. Dang, and M. H. Criqui Peripheral Arterial Disease: Morbidity and Mortality Implications Circulation, August 15, 2006; 114(7): 688 - 699. [Full Text] [PDF]

				P. C. Strike, K. Magid, L. Brydon, S. Edwards, J. R. McEwan, and A. Steptoe Exaggerated Platelet and Hemodynamic Reactivity to Mental Stress in Men With Coronary Artery Disease Psychosom Med, July 1, 2004; 66(4): 492 - 500. [Abstract] [Full Text] [PDF]

				M. E Fonteyn A nurse led smoking cessation intervention increased cessation rates after hospital admission for coronary heart disease Evid. Based Nurs., April 1, 2004; 7(2): 46 - 46. [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]

				P. P. Chang, D. E. Ford, L. A. Meoni, N.-Y. Wang, and M. J. Klag Anger in Young Men and Subsequent Premature Cardiovascular Disease: The Precursors Study Arch Intern Med, April 22, 2002; 162(8): 901 - 906. [Abstract] [Full Text] [PDF]

				G. A. Beller and B. L. Zaret Contributions of Nuclear Cardiology to Diagnosis and Prognosis of Patients With Coronary Artery Disease Circulation, March 28, 2000; 101(12): 1465 - 1478. [Full Text] [PDF]

				A STEPTOE Psychosocial factors in the aetiology of coronary heart disease Heart, September 1, 1999; 82(3): 258 - 259. [Full Text] [PDF]