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Relationship among mental stress–induced ischemia and ischemia during daily life and during exercise: the Psychophysiologic Investigations of Myocardial Ischemia (PIMI) Study

Peter H. Stone, MD, FACC^*, David S. Krantz, PhD, Robert P. McMahon, PhD, A. David Goldberg, MD, FACC, Lewis C. Becker, MD, FACC^||, Bernard R. Chaitman, MD, FACC^¶, Herman A. Taylor, MD, FACC^||||, Jerome D. Cohen, MD^#, Kenneth E. Freedland, PhD^¶¶, Barry D. Bertolet, MD, FACC, Cecil Coughlan, MD^**, Carl J. Pepine, MD, FACC, Peter G. Kaufmann, PhD, David S. Sheps, MD, FACC for the PIMI Study Group

^* Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts, USA
University of the Health Sciences Dept of Medical and Clinical Psychology, Bethesda, Maryland, USA
Maryland Medical Research Institute, Baltimore, Maryland, USA
Henry Ford Hospital, Division of Cardiology, Detroit, Michigan, USA
^|| Johns Hopkins University, Baltimore, Maryland, USA
^¶ St. Louis University, Division of Cardiology, St. Louis, Missouri, USA
^# Health Sciences Center, St. Louis, Missouri, USA
^** University of Alabama Medical Center, Cardiology Division, Birmingham, Alabama, USA
University of Florida, Health Science Center, Gainesville, Florida, USA
National Heart, Lung and Blood Institute, Bethesda, Maryland, USA
Division of Cardiology, East Tennessee State University, James H. Quillen College of Medicine, Johnson City, Tennessee, USA
^|||| Jackson Medical Mall, Jackson, Milwaukee, USA
^¶¶ Washington University, St. Louis, Missouri, USA

View larger version (25K): [in a new window]   Figure 1 Hemodynamic responses during the Speech test in the 82 patients who experienced ischemia during routine daily activities and the 189 patients without ambulatory electrocardiographic ischemia. For each hemodynamic variable the values are shown for patients who experienced daily life ischemia (Y) and those who did not (N). The open area of each bar represents the value at rest and the dark area of each bar represents the change during the mental stress. BP = blood pressure (mm Hg); CO = cardiac output (liters/min); EF = ejection fraction (%); HR = heart rate (bpm); SV = stroke volume (ml/beat); SVR = systemic vascular resistance (dyn/s/cm3). P values <0.10 are reported; p values 0.10 are noted as pNS.

View larger version (45K): [in a new window]   Figure 2 Frequency of ischemia on 48-h ambulatory electrocardiogram (AECG) by presence of criteria for ischemia induced by mental stress or bicycle exercise. Radionuclide ventriculography (RVG) wall motion criteria: 1) mental stress—new or worsened regional wall motion abnormalities during both mental stress images; 2) bicycle exercise—new or worsened regional wall motion abnormality during peak exercise image. Radionuclide ventriculography ejection fraction (EF) criteria: 1) mental stress—EF decrease >8%; 2) bicycle exercise—EF does not increase 5%. ST segment depression criterion: mental stress or bicycle exercise—1 mm ST segment depression for 1 min on AECG or 1 mm ST segment depression on 12-lead electrocardiogram. n = number with criteria present during stress test. P values <0.10 are reported, p values 0.10 are noted as pNS. Open bars = ischemia; shaded bars = no ischemia.