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Effects of mental stress on coronary epicardial vasomotion and flow velocity in coronary artery disease: relationship with hemodynamic stress responses¹

Willem J. Kop, PhD^* , David S. Krantz, PhD^* , Robert H. Howell, PhD^*, Michael A. Ferguson, MD^*, Vasilios Papademetriou, MD, FACC, David Lu, MD, Jeffrey J. Popma, MD, FACC, John F. Quigley, MA^*, Marina Vernalis, DO, FACC^* and John S. Gottdiener, MD, FACC^||

^* Department of Medical and Clinical Psychology, Uniformed Services, University of the Health Sciences, Bethesda, Maryland, USA
Division of Cardiology, Department of Medicine, Georgetown University Medical Center, Washington, D.C., USA
Department of Cardiology, Veterans Affairs Medical Center, Washington, D.C., USA
Department of Cardiology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
^|| Department of Cardiology?1, St. Francis Hospital, Roslyn, New York, USA

View larger version (15K): [in a new window]   Figure 1 Coronary flow velocity response to mental stress in patients with coronary artery disease (CAD) compared with patients free of angiographic CAD. Average peak velocity (vertical axis) increased significantly during mental stress in patients without CAD (32.8%, p = 0.008), whereas no such increase occurred in patients with CAD (6.4%; p = >0.10; pgroup x response interaction = 0.006). No group differences (CAD vs. non-CAD) were found in pretask resting velocity measures (29.7 ± 17.9 cm/s vs. 30.4 ± 17.5 cm/s, respectively, p > 0.10).

View larger version (20K): [in a new window]   Figure 2 Associations between diastolic blood pressure reactivity to mental stress and coronary vasomotion in diseased and nonstenotic segments of patients with coronary artery disease. An inverse relationship was found between diastolic blood pressure responses and coronary diameter changes in diseased segments (rDBP = –0.30, p = 0.02), whereas no relationship was found between blood pressure responses and coronary constriction in nonstenotic arteries (rDBP = –0.02, p > 0.10). This finding was confirmed by multivariate regression analysis.

View larger version (16K): [in a new window]   Figure 3 Differential coronary vasomotor response in patients with low, moderate and high diastolic blood pressure (DBP) responses to mental stress. High diastolic blood pressure responders (upper tertile) displayed significantly more coronary constriction compared to low responders (analysis of variance p = 0.02).