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Hu JR, Abdullah A, Nanna MG, Soufer R. The Brain-Heart Axis: Neuroinflammatory Interactions in Cardiovascular Disease. Curr Cardiol Rep 2023; 25:1745-1758. [PMID: 37994952 PMCID: PMC10908342 DOI: 10.1007/s11886-023-01990-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 11/24/2023]
Abstract
PURPOSE OF REVIEW The role of neuroimmune modulation and inflammation in cardiovascular disease has been historically underappreciated. Physiological connections between the heart and brain, termed the heart-brain axis (HBA), are bidirectional, occur through a complex network of autonomic nerves/hormones and cytokines, and play important roles in common disorders. RECENT FINDINGS At the molecular level, advances in the past two decades reveal complex crosstalk mediated by the sympathetic and parasympathetic nervous systems, the renin-angiotensin aldosterone and hypothalamus-pituitary axes, microRNA, and cytokines. Afferent pathways amplify proinflammatory signals via the hypothalamus and brainstem to the periphery, promoting neurogenic inflammation. At the organ level, while stress-mediated cardiomyopathy is the prototypical disorder of the HBA, cardiac dysfunction can result from a myriad of neurologic insults including stroke and spinal injury. Atrial fibrillation is not necessarily a causative factor for cardioembolic stroke, but a manifestation of an abnormal atrial substrate, which can lead to the development of stroke independent of AF. Central and peripheral neurogenic proinflammatory factors have major roles in the HBA, manifesting as complex bi-directional relationships in common conditions such as stroke, arrhythmia, and cardiomyopathy.
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Affiliation(s)
- Jiun-Ruey Hu
- Section of Cardiovascular Medicine, Yale School of Medicine, 789 Howard Ave, New Haven, CT, 06519, USA
| | - Ahmed Abdullah
- Section of Cardiovascular Medicine, Yale School of Medicine, 789 Howard Ave, New Haven, CT, 06519, USA
| | - Michael G Nanna
- Section of Cardiovascular Medicine, Yale School of Medicine, 789 Howard Ave, New Haven, CT, 06519, USA
| | - Robert Soufer
- Section of Cardiovascular Medicine, Yale School of Medicine, 789 Howard Ave, New Haven, CT, 06519, USA.
- VA Connecticut Healthcare System, 950 Campbell Ave, -111B, West Haven, CT, 06516, USA.
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2
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Rozanski A. Introduction to cardiology and lifestyle medicine. Prog Cardiovasc Dis 2023; 77:1-3. [PMID: 37080263 DOI: 10.1016/j.pcad.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Affiliation(s)
- Alan Rozanski
- Division of Cardiology, Mount Sinai Morningside Hospital, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, Egypt.
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3
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Rozanski A, Blumenthal JA, Hinderliter AL, Cole S, Lavie C. Cardiology and lifestyle medicine. Prog Cardiovasc Dis 2023; 77:4-13. [PMID: 37059409 DOI: 10.1016/j.pcad.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 04/09/2023] [Indexed: 04/16/2023]
Abstract
Poor lifestyle habits, such as physical inactivity and poor diets, are highly prevalent within society and even more so among patients with chronic disease. The need to stem poor lifestyle habits has led to the development of a new field of Lifestyle Medicine, whose mission is to prevent, treat, and even reverse chronic diseases through lifestyle interventions. Three fields within Cardiology relate to this mission: Cardiac Rehabilitation, Preventive Cardiology, and Behavioral Cardiology. Each of these three fields have contributed substantially to the reduction of cardiovascular disease (CVD) morbidity and mortality. The historic contributions of these three cardiac fields are reviewed as well as the challenges each of these fields has faced in optimizing the application of lifestyle medicine practices. A shared agenda between Cardiology and the American College of Lifestyle Medicine could further the utilization of behavioral interventions. This review suggests seven steps that could be shared by these organizations and other medical societies. First, there is a need to develop and promulgate the assessment of lifestyle factors as "vital signs" during patient visits. Second, developing a strong partnership between the fields of Cardiology and Physiatry could improve important aspects of cardiac care, including a potential redesign of cardiac stress testing. Third, behavioral evaluations should be optimized at patients' entrée points into medical care since these may be considered "windows of opportunity". Fourth, there is a need to broaden cardiac rehabilitation into inexpensive programs and make this program eligible for patients with risk factors but no known CVD. Fifth, lifestyle medicine education should be integrated into the core competencies for relevant specialties. Sixth, there is a need for inter-societal advocacy to promote lifestyle medicine practices. Seventh, the well-being effects of healthy lifestyle behaviors, such as their impact on one's sense of vitality, should be emphasized.
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Affiliation(s)
- Alan Rozanski
- Division of Cardiology, Mount Sinai Morningside Hospital, Mount Sinai Heart, and the Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
| | - James A Blumenthal
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States of America
| | - Alan L Hinderliter
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Steven Cole
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States of America; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, United States of America
| | - Carl Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the UQ School of Medicine, New Orleans, LA, United States of America
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4
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Maleczek M, Schebesta K, Hamp T, Burger AL, Pezawas T, Krammel M, Roessler B. ST-T segment changes in prehospital emergency physicians in the field: a prospective observational trial. Scand J Trauma Resusc Emerg Med 2022; 30:47. [PMID: 35841049 PMCID: PMC9288087 DOI: 10.1186/s13049-022-01033-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 06/30/2022] [Indexed: 12/03/2022] Open
Abstract
Aims Due to time-critical decision-making, physical strain and the uncontrolled environment, prehospital emergency management is frequently associated with high levels of stress in medical personnel. Stress has been known to cause ischemia like changes in electrocardiograms (ECGs), including arrhythmias and deviations in ST-T segments. There is a lack of knowledge regarding the occurrence of changes in ST-T segments in prehospital emergency physicians. We hypothesized that ST-T segment deviations occur in prehospital emergency physicians in the field.
Methods In this prospective observational trial, ST-T segments of emergency physicians were recorded using 12-lead Holter ECGs. The primary outcome parameter was defined as the incidence of ST-T segment changes greater than 0.1 mV in two corresponding leads for more than 30 s per 100 rescue missions. The secondary outcomes included T-wave inversions and ST-segment changes shorter than 30 s or smaller than 0.1 mV. Surrogate parameters of stress were measured using the NASA-Task Load Index and cognitive appraisal, and their correlation with ST-T segment changes were also assessed. Results Data from 20 physicians in 36 shifts (18 days, 18 nights) including 208 missions were analysed. Seventy percent of previously healthy emergency physicians had at least one ECG abnormality; the mean duration of these changes was 30 s. Significantly more missions with ECG changes were found during night than day shifts (39 vs. 17%, p < 0.001). Forty-nine ECG changes occurred between missions. No ST-T segment changes > 30 s and > 0.1 mV were found. Two ST-T segment changes < 30 s or < 0.1 mV (each during missions) and 122 episodes of T-wave inversions (74 during missions) were identified. ECG changes were found to be associated with alarms when asleep and NASA task load index. Conclusion ECG changes are frequent and occur in most healthy prehospital emergency physicians. Even when occurring for less than 30 s, such changes are important signs for high levels of stress. The long-term impact of these changes needs further investigation. Trial registration The trial was registered at ClinicalTrials.gov (NCT04003883) on 1.7.2019: https://clinicaltrials.gov/ct2/show/NCT04003883?term=emergency+physician&rank=2
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Affiliation(s)
- Mathias Maleczek
- Medical Simulation and Emergency Management Research Group, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.,Academic Simulation Center of Vienna, Vienna, Austria
| | - Karl Schebesta
- Medical Simulation and Emergency Management Research Group, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. .,Academic Simulation Center of Vienna, Vienna, Austria.
| | - Thomas Hamp
- Medical Simulation and Emergency Management Research Group, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Achim Leo Burger
- Department of Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Thomas Pezawas
- Department of Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Mario Krammel
- Emergency Medical Service Vienna, Vienna, Austria.,PULS - Austrian Cardiac Arrest Awareness Association, Vienna, Austria
| | - Bernhard Roessler
- Medical Simulation and Emergency Management Research Group, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.,Academic Simulation Center of Vienna, Vienna, Austria
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5
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Levine GN. Psychological Stress and Heart Disease: Fact or Folklore? Am J Med 2022; 135:688-696. [PMID: 35278355 DOI: 10.1016/j.amjmed.2022.01.053] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 01/20/2022] [Accepted: 01/23/2022] [Indexed: 01/04/2023]
Abstract
For at least a few centuries, if not millennia, psychological stress has been popularly believed to contribute to heart disease. Does psychological stress really contribute to heart disease? Are anecdotal, patient, and lay press reports that angina, heart attack, and even cardiac death are caused by stress based on fact, or are they just folklore? In this review, the study data supporting associations between stress and cardiovascular risk, as well as potential mechanisms by which psychological stress might contribute to heart disease and precipitate myocardial ischemia and infarction, are critically reviewed and summarized.
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Affiliation(s)
- Glenn N Levine
- Baylor College of Medicine, Houston, Texas; Cardiology Section, Michael E. DeBakey VA Medical Center, Houston, Texas.
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6
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Sara JDS, Toya T, Ahmad A, Clark MM, Gilliam WP, Lerman LO, Lerman A. Mental Stress and Its Effects on Vascular Health. Mayo Clin Proc 2022; 97:951-990. [PMID: 35512885 PMCID: PMC9058928 DOI: 10.1016/j.mayocp.2022.02.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 01/24/2022] [Accepted: 02/08/2022] [Indexed: 01/13/2023]
Abstract
Coronary artery disease continues to be a major cause of morbidity and mortality despite significant advances in risk stratification and management. This has prompted the search for alternative nonconventional risk factors that may provide novel therapeutic targets. Psychosocial stress, or mental stress, has emerged as an important risk factor implicated in a higher incidence of cardiovascular events, and although our understanding of this far ranging and interesting phenomenon has developed greatly over recent times, there is still much to be learned regarding how to measure mental stress and how it may impact physical health. With the current coronavirus disease 2019 global pandemic and its incumbent lockdowns and social distancing, understanding the potentially harmful biological effects of stress related to life-changing events and social isolation has become even more important. In the current review our multidisciplinary team discusses stress from a psychosocial perspective and aims to define psychological stress as rigorously as possible; discuss the pathophysiologic mechanisms by which stress may mediate cardiovascular disease, with a particular focus to its effects on vascular health; outline existing methods and approaches to quantify stress by means of a vascular biomarker; outline the mechanisms whereby psychosocial stressors may have their pathologic effects ultimately transduced to the vasculature through the neuroendocrine immunologic axis; highlight areas for improvement to refine existing approaches in clinical research when studying the consequences of psychological stress on cardiovascular health; and discuss evidence-based therapies directed at reducing the deleterious effects of mental stress including those that target endothelial dysfunction. To this end we searched PubMed and Google Scholar to identify studies evaluating the relationship between mental or psychosocial stress and cardiovascular disease with a particular focus on vascular health. Search terms included "myocardial ischemia," "coronary artery disease," "mental stress," "psychological stress," "mental∗ stress∗," "psychologic∗ stress∗," and "cardiovascular disease∗." The search was limited to studies published in English in peer-reviewed journals between 1990 and the present day. To identify potential studies not captured by our database search strategy, we also searched studies listed in the bibliography of relevant publications and reviews.
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Key Words
- cad, coronary artery disease
- cbt, cognitive behavioral therapy
- cvd, cardiovascular disease
- fmd, flow-mediated dilatation
- il, interleukin
- mi, myocardial infarction
- ms, mental stress
- msimi, mental stress induced myocardial ischemia
- pat, peripheral arterial tonometry
- ped, peripheral endothelial dysfunction
- pet, positron emission tomography
- rh, reactive hyperemia
- ses, socioeconomic status
- tnf, tumor necrosis factor
- vsmc, vascular smooth muscle cells
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Affiliation(s)
| | - Takumi Toya
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Ali Ahmad
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Matthew M Clark
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Wesley P Gilliam
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Lliach O Lerman
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Amir Lerman
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
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7
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Association between quality of life and mental stress-induced myocardial ischaemia in high-risk patients after coronary revascularization. Health Qual Life Outcomes 2022; 20:69. [PMID: 35473557 PMCID: PMC9044723 DOI: 10.1186/s12955-022-01976-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/14/2022] [Indexed: 11/13/2022] Open
Abstract
Objective We sought to determine the association between mental stress-induced myocardial ischaemia (MSIMI) and quality of life (QoL) in patients with coronary artery disease (CAD) after coronary revascularization.
Methods This cohort study involved patients with high-risk MSIMI who received coronary revascularization between Dec 2018 and Dec 2019. Patients who screened positive for depression/anxiety were enrolled in this study. Mental stress was induced by the Stroop Colour and Word Test 1 month after coronary revascularization. All participants underwent single photon emission computed tomography (SPECT) scans at rest and under mental stress. MSIMI was defined as the presence of four abnormal SPECT phenomena. QoL was assessed using the Seattle Angina Questionnaire (SAQ) prior to treatment and 1 month after coronary revascularization. Results Of the 1845 consecutive patients who received coronary revascularization, 590 (31.9%) had depression/anxiety, and 205 agreed to accept the mental stress test. During the average observation period of 33 days, 105 (51.2%) patients exhibited MSIMI. All SAQ subscales showed significant improvement, except for QoL, in the MSIMI group. The QoL score was lower (− 0.2 ± 32.7 vs. 13.1 ± 29.9, P = 0.005), and the proportion of deterioration in QoL was higher (50.5% vs. 31.9%, P = 0.010) in the MSIMI group than in the non-MSIMI group. Those with a deterioration in QoL had approximately twice the rate of MSIMI than those with an improvement in QoL (unadjusted OR: 2.019, 95% CI 1.122–3.634, P = 0.026; adjusted OR: 1.968, 95% CI 1.083–3.578, P = 0.017). Conclusion Among patients with CAD who received coronary revascularization and had depression/anxiety, deterioration in QoL increased the likelihood of MSIMI. Hence, our results indicate that deterioration in QoL is a predictor of MSIMI. Trail Registration ChiCTR2200055792, retrospectively registered, 2022.1.20, www.medresman.org.cn
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8
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Ischemia and no obstructive coronary arteries in patients with stable ischemic heart disease. Int J Cardiol 2022; 348:1-8. [PMID: 34902504 PMCID: PMC8779638 DOI: 10.1016/j.ijcard.2021.12.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 11/30/2021] [Accepted: 12/08/2021] [Indexed: 02/03/2023]
Abstract
A large proportion of patients with suspected obstructive coronary artery disease (CAD) is found to have ischemia with no obstructive coronary artery disease (INOCA). Based on current evidence, these patients are at increased risk of adverse cardiovascular events, even though they have no obstructive CAD. Importantly, INOCA is associated with recurrent clinical presentations with chest pain, impaired functional capacity, reduced health-related quality of life, and high healthcare costs. Underlying coronary microvascular dysfunction (CMD), through endothelium-dependent and independent mechanisms contribute to these adverse outcomes in INOCA. While non-invasive and invasive diagnostic testing has typically focused on identification of obstructive CAD in symptomatic patients, functional testing to detect coronary epicardial and microvascular dysfunction should be considered in those with INOCA who have persistent angina. Current diagnostic methods to clarify functional abnormalities and treatment strategies for epicardial and/or microvascular dysfunction in INOCA are reviewed.
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9
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Mehta PK, Sharma A, Bremner JD, Vaccarino V. Mental Stress-Induced Myocardial Ischemia. Curr Cardiol Rep 2022; 24:2109-2120. [PMID: 36322365 PMCID: PMC9628301 DOI: 10.1007/s11886-022-01821-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW To summarize recent evidence on mental stress-induced myocardial ischemia (MSIMI), its mechanisms, and clinical significance. RECENT FINDINGS MSIMI can occur in patients with normal cardiac stress testing, is only weakly related to severity of coronary artery disease (CAD), and it is often silent. Among patients with CAD, MSIMI is associated with a twofold increased risk of major adverse cardiovascular events compared to those who do not have MSIMI. Certain groups such as young women with myocardial infarction and those with psychological comorbidities are more susceptible to MSIMI. Abnormal microvascular vasoreactivity and inflammation are implicated mechanisms in MSIMI. Increased brain activity in regions that modulate autonomic reactivity to emotional stress and fear is associated with MSIMI. MSIMI has important prognostic implications in patients with CAD. Stress can no longer be ignored as a risk factor in cardiology care. Clinical trials testing effective strategies to target MSIMI are needed.
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Affiliation(s)
- Puja K. Mehta
- grid.189967.80000 0001 0941 6502Division of Cardiology, Emory Women’s Heart Center and Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA 30322 USA
| | - Ashish Sharma
- grid.259906.10000 0001 2162 9738Internal Medicine Residency Program, Mercer University School of Medicine, Macon, GA USA
| | - J. Douglas Bremner
- grid.189967.80000 0001 0941 6502Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA USA ,grid.414026.50000 0004 0419 4084Atlanta VA Medical Center, Decatur, GA USA
| | - Viola Vaccarino
- grid.189967.80000 0001 0941 6502Division of Cardiology, Emory Women’s Heart Center and Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA 30322 USA ,grid.189967.80000 0001 0941 6502Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA USA
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10
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Anastasiou A, Cribben I, Fryzlewicz P. Cross-covariance isolate detect: A new change-point method for estimating dynamic functional connectivity. Med Image Anal 2021; 75:102252. [PMID: 34700242 DOI: 10.1016/j.media.2021.102252] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 11/24/2022]
Abstract
Evidence of the non stationary behavior of functional connectivity (FC) networks has been observed in task based functional magnetic resonance imaging (fMRI) experiments and even prominently in resting state fMRI data. This has led to the development of several new statistical methods for estimating this time-varying connectivity, with the majority of the methods utilizing a sliding window approach. While computationally feasible, the sliding window approach has several limitations. In this paper, we circumvent the sliding window, by introducing a statistical method that finds change-points in FC networks where the number and location of change-points are unknown a priori. The new method, called cross-covariance isolate detect (CCID), detects multiple change-points in the second-order (cross-covariance or network) structure of multivariate, possibly high-dimensional time series. CCID allows for change-point detection in the presence of frequent changes of possibly small magnitudes, can assign change-points to one or multiple brain regions, and is computationally fast. In addition, CCID is particularly suited to task based data, where the subject alternates between task and rest, as it firstly attempts isolation of each of the change-points within subintervals, and secondly their detection therein. Furthermore, we also propose a new information criterion for CCID to identify the change-points. We apply CCID to several simulated data sets and to task based and resting state fMRI data and compare it to recent change-point methods. CCID may also be applicable to electroencephalography (EEG), magentoencephalography (MEG) and electrocorticography (ECoG) data. Similar to other biological networks, understanding the complex network organization and functional dynamics of the brain can lead to profound clinical implications. Finally, the R package ccid implementing the method from the paper is available from CRAN.
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Affiliation(s)
| | - Ivor Cribben
- Department of Accounting and Business Analytics, Alberta School of Business, University of Alberta Canada.
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11
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Pinna V, Doneddu A, Roberto S, Magnani S, Ghiani G, Mulliri G, Sanna I, Serra S, Hosseini Kakhak SA, Milia R, Fadda D, Lecis R, Guicciardi M, Crisafulli A. Combined mental task and metaboreflex impair cerebral oxygenation in patients with type 2 diabetes mellitus. Am J Physiol Regul Integr Comp Physiol 2021; 320:R488-R499. [PMID: 33533319 DOI: 10.1152/ajpregu.00288.2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Cardiovascular regulation is altered by type 2 diabetes mellitus (DM2), producing an abnormal response to muscle metaboreflex. During physical exercise, cerebral blood flow is impaired in patients with DM2, and this phenomenon may reduce cerebral oxygenation (COX). We hypothesized that the simultaneous execution of a mental task (MT) and metaboreflex activation would reduce COX in patients with DM2. Thirteen individuals suffering from DM2 (6 women) and 13 normal age-matched controls (CTL, 6 women) participated in this study. They underwent five different tests, each lasting 12 min: postexercise muscle ischemia (PEMI) to activate the metaboreflex, control exercise recovery (CER), PEMI + MT, CER + MT, and MT alone. COX was evaluated using near-infrared spectroscopy with sensors applied to the forehead. Central hemodynamics was assessed using impedance cardiography. We found that when MT was superimposed on the PEMI-induced metaboreflex, patients with DM2 could not increase COX to the same extent reached by the CTL group (101.13% ± 1.08% vs. 104.23% ± 2.51%, P < 0.05). Moreover, patients with DM2 had higher mean blood pressure and systemic vascular resistance as well as lower stroke volume and cardiac output levels compared with the CTL group, throughout our experiments. It was concluded that patients with DM2 had reduced capacity to enhance COX when undertaking an MT during metaboreflex. Results also confirm that patients with DM2 had dysregulated hemodynamics during metaboreflex, with exaggerated blood pressure response and vasoconstriction. This may have implications for these patients' lack of inclination to exercise.
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Affiliation(s)
- Virginia Pinna
- The Sports Physiology Laboratory, University of Cagliari, Sardinia, Italy.,International PhD in Innovation Sciences and Technologies, University of Cagliari, Sardinia, Italy
| | - Azzurrra Doneddu
- The Sports Physiology Laboratory, University of Cagliari, Sardinia, Italy
| | - Silvana Roberto
- The Sports Physiology Laboratory, University of Cagliari, Sardinia, Italy
| | - Sara Magnani
- The Sports Physiology Laboratory, University of Cagliari, Sardinia, Italy.,International PhD in Innovation Sciences and Technologies, University of Cagliari, Sardinia, Italy
| | - Giovanna Ghiani
- The Sports Physiology Laboratory, University of Cagliari, Sardinia, Italy
| | - Gabriele Mulliri
- The Sports Physiology Laboratory, University of Cagliari, Sardinia, Italy.,International PhD in Innovation Sciences and Technologies, University of Cagliari, Sardinia, Italy
| | - Irene Sanna
- The Sports Physiology Laboratory, University of Cagliari, Sardinia, Italy
| | - Stefano Serra
- The Sports Physiology Laboratory, University of Cagliari, Sardinia, Italy
| | | | - Raffaele Milia
- The Sports Physiology Laboratory, University of Cagliari, Sardinia, Italy
| | - Daniela Fadda
- The Department of Pedagogy, Psychology, Philosophy, University of Cagliari, Sardinia, Italy
| | - Romina Lecis
- The Department of Pedagogy, Psychology, Philosophy, University of Cagliari, Sardinia, Italy
| | - Marco Guicciardi
- The Department of Pedagogy, Psychology, Philosophy, University of Cagliari, Sardinia, Italy
| | - Antonio Crisafulli
- The Sports Physiology Laboratory, University of Cagliari, Sardinia, Italy.,International PhD in Innovation Sciences and Technologies, University of Cagliari, Sardinia, Italy
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12
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Liu Y, Kong B, Ma H, Guo L, Bai B, Yu X, Liu F, Wang H, Fei H, Geng Q, Jiang W. Consistency of Positron Emission Tomography and Myocardial Contrast Echocardiography in Diagnosing Mental Stress-Induced Myocardial Ischemia: Study Protocol of a Prospective Study-Background, Design and Method. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:3200-3209. [PMID: 32900539 DOI: 10.1016/j.ultrasmedbio.2020.07.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 06/30/2020] [Accepted: 07/30/2020] [Indexed: 06/11/2023]
Abstract
Mental stress-induced myocardial ischemia (MSIMI) has attracted increasing attention in the last 30 y. Positron emission tomography/computed tomography (PET/CT) is among the most accurate methods for evaluating myocardial perfusion. Even so, echocardiography seems to be a more harmless option when the radiation exposure and high expense of PET/CT are considered. To date, no previous studies have compared the consistency between echocardiography and PET/CT in the diagnosis of MSIMI. The primary aim of this research was to compare the consistency of myocardial contrast echocardiography and PET/CT in diagnosing MSIMI in women with angina symptom/ischemia but no obstructive coronary artery disease (INOCA). Fifty adult female patients with INOCA were recruited for a 12-min-long mental stress test. Each patient underwent both echocardiography and PET/CT at baseline and during mental stress testing; the interval between the two examinations was 1-3 d and the sequence was assigned naturally. MSIMI is defined by a summed difference score (SDS) ≥3 on PET-CT during mental stress testing. It is also defined by new abnormal wall motion, ejection fraction reduction ≥5%, and/or development of ischemic ST change on the electrocardiogram during mental stress testing. This study examined the consistency of PET/CT and myocardial contrast echocardiography in diagnosing MSIMI.
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Affiliation(s)
- Yuting Liu
- School of Medicine, South China University of Technology, Department of Cardiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou 510080,China
| | - Bo Kong
- Department of Echo Room, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Huan Ma
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Lan Guo
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Bingqing Bai
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Xueju Yu
- School of Medicine, South China University of Technology, Department of Cardiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou 510080,China
| | - Fengyao Liu
- School of Medicine, South China University of Technology, Department of Cardiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou 510080,China
| | - Haochen Wang
- School of Medicine, South China University of Technology, Department of Cardiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou 510080,China
| | - Hongwen Fei
- Department of Echo Room, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Qingshan Geng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China.
| | - Wei Jiang
- Department of Internal Medicine, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
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13
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Shah SM, Meadows JL, Burg MM, Pfau S, Soufer R. Effects of Psychological Stress on Vascular Physiology: Beyond the Current Imaging Signal. Curr Cardiol Rep 2020; 22:156. [PMID: 33037500 DOI: 10.1007/s11886-020-01406-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2020] [Indexed: 01/13/2023]
Abstract
PURPOSE OF REVIEW This review describes the effects of psychological stress on the physiology of the entire vascular system, from individual cellular components to macrovascular and microvascular responses, and highlights the importance of the vascular system in the context of current limitations in cardiac imaging for evaluation of the cardiovascular response to mental stress. RECENT FINDINGS The physiological responses that mediate vascular changes are based on evolutionary needs, but there is increasing evidence that the long-term consequences of psychological stress can precipitate the development and progression of cardiovascular disease (CVD). While there is an extensive body of literature describing localized physiological responses or overt cardiovascular manifestations, often framed within the organ-specific scope of cardiovascular imaging, there has not been a comprehensive description of the global vascular effects of psychological stress. Given the global nature of these processes, targeted cardiovascular imaging modalities may be insufficient. Here we approach the vascular response to mental stress systematically, describing the effects on the endothelium, vascular smooth muscle, and adventitia. We then address the mental stress effects on large vessels and the microvascular compartment, with a discussion of the role of microvascular resistance in the pathophysiology of mental stress-induced myocardial ischemia. Vascular responses to psychological stress involve complex physiological processes that are not fully characterized by routine cardiovascular imaging assessments. Future research incorporating standardized psychological assessments targeted toward vascular mechanisms of stress responses is required to guide the development of behavioral and therapeutic interventions.
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Affiliation(s)
- Samit M Shah
- Section of Cardiovascular Medicine, Yale School of Medicine, 950 Campbell Ave./111B, West Haven, CT, 06516, USA.,VA Connecticut Healthcare System, West Haven, CT, USA
| | - Judith L Meadows
- Section of Cardiovascular Medicine, Yale School of Medicine, 950 Campbell Ave./111B, West Haven, CT, 06516, USA.,VA Connecticut Healthcare System, West Haven, CT, USA
| | - Matthew M Burg
- Section of Cardiovascular Medicine, Yale School of Medicine, 950 Campbell Ave./111B, West Haven, CT, 06516, USA.,VA Connecticut Healthcare System, West Haven, CT, USA
| | - Steven Pfau
- Section of Cardiovascular Medicine, Yale School of Medicine, 950 Campbell Ave./111B, West Haven, CT, 06516, USA.,VA Connecticut Healthcare System, West Haven, CT, USA
| | - Robert Soufer
- Section of Cardiovascular Medicine, Yale School of Medicine, 950 Campbell Ave./111B, West Haven, CT, 06516, USA. .,VA Connecticut Healthcare System, West Haven, CT, USA.
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14
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Abstract
Lifestyle medicine is a growing field of medicine that addresses key health behaviors, which are the root causes of most premature death, chronic disease, and health care costs. Coaching patients with evidence-based behavior change strategies can help them to make lasting habits in key areas, such as physical activity, healthy eating, improved sleep, cessation of tobacco, forming and maintaining relationships, and stress management. Similarities in philosophy between lifestyle medicine and physical medicine and rehabilitation make them complementary and synergistic in treating the whole patient in their social context.
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15
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Meadows JL, Shah S, Burg MM, Pfau S, Soufer R. Cardiovascular Imaging of Biology and Emotion: Considerations Toward a New Paradigm. Circ Cardiovasc Imaging 2020; 13:e011054. [PMID: 32762255 DOI: 10.1161/circimaging.120.011054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Central activation in response to emotion and cognitive stress induces perturbations in the heart and the peripheral vasculature that differ in physiology and clinical manifestations when compared with exercise-induced changes. While our conventional framework of epicardial coronary artery disease is foundational in cardiology, an expanded paradigm is required to address the cardiovascular response to mental stress (MS) and its associated risks, thus addressing the intersection of the patient's ecological and psychosocial experience with cardiovascular biology. To advance the field of MS in cardiovascular health, certain core challenges must be addressed. These include differences in the trigger activation between exercise and emotion, identification and interpretation of imaging cues as measures of pathophysiologic changes, characterization of the vascular response, and identification of central and peripheral treatment targets. Sex and psychosocial determinants of health are important in understanding the emerging overlap of MS-induced myocardial ischemia with microvascular dysfunction and symptoms in the absence of obstructive disease. In overcoming these critical knowledge gaps, integration of the field of MS will require implementation studies to guide use of MS testing, to support diagnosis of MS induced cardiac and vascular pathophysiology, to assess prognosis, and understand the role of endotying to direct therapy.
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Affiliation(s)
- Judith L Meadows
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (J.L.M., S.S., M.M.B., S.P., R.S.).,VA Connecticut Healthcare System, West Haven, CT (J.L.M., S.S., M.M.B., S.P., R.S.)
| | - Samit Shah
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (J.L.M., S.S., M.M.B., S.P., R.S.).,VA Connecticut Healthcare System, West Haven, CT (J.L.M., S.S., M.M.B., S.P., R.S.)
| | - Matthew M Burg
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (J.L.M., S.S., M.M.B., S.P., R.S.).,VA Connecticut Healthcare System, West Haven, CT (J.L.M., S.S., M.M.B., S.P., R.S.)
| | - Steven Pfau
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (J.L.M., S.S., M.M.B., S.P., R.S.).,VA Connecticut Healthcare System, West Haven, CT (J.L.M., S.S., M.M.B., S.P., R.S.)
| | - Robert Soufer
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (J.L.M., S.S., M.M.B., S.P., R.S.).,VA Connecticut Healthcare System, West Haven, CT (J.L.M., S.S., M.M.B., S.P., R.S.)
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16
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Bremner JD, Wittbrodt MT, Shah AJ, Pearce BD, Gurel NZ, Inan OT, Raggi P, Lewis TT, Quyyumi AA, Vaccarino V. Confederates in the Attic: Posttraumatic Stress Disorder, Cardiovascular Disease, and the Return of Soldier's Heart. J Nerv Ment Dis 2020; 208:171-180. [PMID: 32091470 PMCID: PMC8214871 DOI: 10.1097/nmd.0000000000001100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Da Costa originally described Soldier's Heart in the 19th Century as a syndrome that occurred on the battlefield in soldiers of the American Civil War. Soldier's Heart involved symptoms similar to modern day posttraumatic stress disorder (PTSD) as well as exaggerated cardiovascular reactivity felt to be related to an abnormality of the heart. Interventions were appropriately focused on the cardiovascular system. With the advent of modern psychoanalysis, psychiatric symptoms became divorced from the body and were relegated to the unconscious. Later, the physiology of PTSD and other psychiatric disorders was conceived as solely residing in the brain. More recently, advances in psychosomatic medicine led to the recognition of mind-body relationships and the involvement of multiple physiological systems in the etiology of disorders, including stress, depression PTSD, and cardiovascular disease, has moved to the fore, and has renewed interest in the validity of the original model of the Soldier's Heart syndrome.
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Affiliation(s)
- J. Douglas Bremner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Emory University, Atlanta
- Department of Radiology, Emory University School of Medicine, Emory University, Atlanta
- Atlanta VA Medical Center, Decatur
| | - Matthew T. Wittbrodt
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Emory University, Atlanta
| | - Amit J. Shah
- Atlanta VA Medical Center, Decatur
- Department of Medicine (Cardiology), Emory University School of Medicine, Emory University
| | - Bradley D. Pearce
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Nil Z. Gurel
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, Georgia
| | - Omer T. Inan
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, Georgia
- Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia
| | - Paolo Raggi
- Mazankowski Alberta Heart Institute and Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Tené T. Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Arshed A. Quyyumi
- Department of Medicine (Cardiology), Emory University School of Medicine, Emory University
| | - Viola Vaccarino
- Department of Medicine (Cardiology), Emory University School of Medicine, Emory University
- Department of Epidemiology, Rollins School of Public Health, Emory University
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17
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Zafirovska B, Otljanska M, Petkoska D, Kedev S. RISK FACTOR DISTRIBUTION AND LONG-TERM OUTCOMES IN YOUNG PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION IN MACEDONIA. Acta Clin Croat 2019; 58:583-589. [PMID: 32595241 PMCID: PMC7314289 DOI: 10.20471/acc.2019.58.04.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The aim was to assess coronary artery disease (CAD) risk factor distribution and long-term outcomes in young patients undergoing percutaneous coronary intervention (PCI) in Macedonia. A total of 12,361 PCI patients (from March 2011 to December 2017) were included in the study. Group 1 included 309 young patients aged ≤40 as the main study group, comparing them to 12,052 older PCI patients (group 2) during the study period. We compared CAD risk factor distribution, clinical and procedure characteristics. Additionally, angiographic data, long-term major adverse cardiac and cerebrovascular events (MACCE) and mortality were analyzed in group 1 patients. Median age was 36±4 years in group 1 and 62±11 years in group 2. Male patients predominated in both groups (88% vs.73%). Positive family history for CAD, smoking and obesity was much more common in the young group (p<0.0001). ST segment elevation myocardial infarction (STEMI) primary PCI was also more frequent with 48% of PCI in the young group (p<0.0001). Multivessel CAD and chronic total occlusion interventions were more common in the older group (51% and 28%, respectively; p<0.0001). Procedure duration (31±0.4 vs. 35±22 min) and fluoroscopy time (9±4 vs. 9±12 min) were similar in both groups. There was no difference in access site bleeding (4.8% vs. 4.3%). During the 3.5-year median follow up, MACCE was present in 1.9% of young patients. In conclusion, positive family history for CAD, obesity and smoking were the most common risk factors in the young PCI population. Young PCI patients usually had single vessel CAD with STEMI being more frequent as the cause for primary PCI. Long-term annual survival exceeded 99% in these patients with excellent prognosis after PCI.
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Affiliation(s)
| | - Magdalena Otljanska
- University Clinic of Cardiology, Faculty of Medicine, University of St Cyril & Methodius, Skopje, Macedonia
| | - Danica Petkoska
- University Clinic of Cardiology, Faculty of Medicine, University of St Cyril & Methodius, Skopje, Macedonia
| | - Sasko Kedev
- University Clinic of Cardiology, Faculty of Medicine, University of St Cyril & Methodius, Skopje, Macedonia
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18
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Jung SJ, Jeon Y, Lee G, Shim JS, Kim HC. Stressful life events and augmentation index: results from the Cardiovascular and Metabolic Diseases Etiology Research Center. Hypertens Res 2019; 43:45-54. [DOI: 10.1038/s41440-019-0331-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 06/26/2019] [Accepted: 07/01/2019] [Indexed: 11/09/2022]
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19
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Bremner JD, Campanella C, Khan Z, Shah M, Hammadah M, Wilmot K, Mheid IA, Lima BB, Garcia EV, Nye J, Ward L, Kutner MH, Raggi P, Pearce BD, Shah A, Quyyumi A, Vaccarino V. Brain Correlates of Mental Stress-Induced Myocardial Ischemia. Psychosom Med 2019; 80:515-525. [PMID: 29794945 PMCID: PMC6023737 DOI: 10.1097/psy.0000000000000597] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Coronary artery disease (CAD) is a major cause of morbidity and mortality, and despite important advances in our understanding of this disorder, the underlying mechanisms remain under investigation. Recently, increased attention has been placed on the role of behavioral factors such as emotional stress on CAD risk. Brain areas involved in memory and the stress response, including medial prefrontal cortex, insula, and parietal cortex, also have outputs to the peripheral cardiovascular system. The purpose of this study was to assess the effects of mental stress on brain and cardiac function in patients with CAD. METHODS CAD patients (N = 170) underwent cardiac imaging with [Tc-99m] sestamibi single-photon emission tomography at rest and during a public speaking mental stress task. On another day, they underwent imaging of the brain with [O-15] water positron emission tomography (PET) during mental stress (arithmetic and public speaking) and control conditions. RESULTS Patients with mental stress-induced myocardial ischemia showed increased activation with stress in anterior cingulate, inferior frontal gyrus, and parietal cortex (p < .005). This was seen with both arithmetic stress and public speaking stress. Arithmetic stress was additionally associated with left insula activation, and public speaking with right pre/postcentral gyrus and middle temporal gyrus activation (p < .005). CONCLUSIONS These findings suggest that mental stress-induced myocardial ischemia is associated with activation in brain areas involved in the stress response and autonomic regulation of the cardiovascular system. Altered brain reactivity to stress could possibly represent a mechanism through which stress leads to increased risk of CAD-related morbidity and mortality.
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Affiliation(s)
- J. Douglas Bremner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
- Department of Radiology, Emory University School of Medicine, Atlanta, GA
- Atlanta VA Medical Center, Decatur, GA, USA
| | - Carolina Campanella
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Zehra Khan
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Majid Shah
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Muhammad Hammadah
- Department of Medicine (Cardiology), Emory University School of Medicine, Atlanta, GA
| | - Kobina Wilmot
- Department of Medicine (Cardiology), Emory University School of Medicine, Atlanta, GA
| | - Ibhar Al Mheid
- Department of Medicine (Cardiology), Emory University School of Medicine, Atlanta, GA
| | - Bruno B. Lima
- Department of Medicine (Cardiology), Emory University School of Medicine, Atlanta, GA
| | - Ernest V. Garcia
- Department of Radiology, Emory University School of Medicine, Atlanta, GA
| | - Jonathon Nye
- Department of Radiology, Emory University School of Medicine, Atlanta, GA
| | - Laura Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Michael H. Kutner
- Department Biostatistics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Paolo Raggi
- Mazankowski Alberta Heart Institute and the Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Brad D. Pearce
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Amit Shah
- Department of Medicine (Cardiology), Emory University School of Medicine, Atlanta, GA
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Atlanta VA Medical Center, Decatur, GA, USA
| | - Arshed Quyyumi
- Department of Medicine (Cardiology), Emory University School of Medicine, Atlanta, GA
| | - Viola Vaccarino
- Department of Medicine (Cardiology), Emory University School of Medicine, Atlanta, GA
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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20
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Gurel NZ, Carek AM, Inan OT, Levantsevych O, Abdelhadi N, Hammadah M, O’Neal WT, Kelli H, Wilmot K, Ward L, Rhodes S, Pearce BD, Mehta PK, Kutner M, Garcia E, Quyyumi A, Vaccarino V, Raggi P, Bremner JD, Shah AJ. Comparison of autonomic stress reactivity in young healthy versus aging subjects with heart disease. PLoS One 2019; 14:e0216278. [PMID: 31067240 PMCID: PMC6505888 DOI: 10.1371/journal.pone.0216278] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 04/15/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The autonomic response to acute emotional stress can be highly variable, and pathological responses are associated with increased risk of adverse cardiovascular events. We evaluated the autonomic response to stress reactivity of young healthy subjects and aging subjects with coronary artery disease to understand how the autonomic stress response differs with aging. METHODS Physiologic reactivity to arithmetic stress in a cohort of 25 young, healthy subjects (< 30 years) and another cohort of 25 older subjects (> 55 years) with CAD was evaluated using electrocardiography, impedance cardiography, and arterial pressure recordings. Stress-related changes in the pre-ejection period (PEP), which measures sympathetic activity, and high frequency heart rate variability (HF HRV), which measures parasympathetic activity, were analyzed as primary outcomes. RESULTS Mental stress reduced PEP in both groups (p<0.01), although the decrease was 50% greater in the healthy group. Mean HF HRV decreased significantly in the aging group only (p = 0.01). DISCUSSION PEP decreases with stress regardless of health and age status, implying increased sympathetic function. Its decline with stress may be attenuated in CAD. The HF HRV (parasympathetic) stress reactivity is more variable and attenuated in younger individuals; perhaps this is related to a protective parasympathetic reflex. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02657382.
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Affiliation(s)
- Nil Z. Gurel
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States of America
| | - Andrew M. Carek
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States of America
| | - Omer T. Inan
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States of America
| | - Oleksiy Levantsevych
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Naser Abdelhadi
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Muhammad Hammadah
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Wesley T. O’Neal
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Heval Kelli
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Kobina Wilmot
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Laura Ward
- Department of Biostatistics & Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Steven Rhodes
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Brad D. Pearce
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Puja K. Mehta
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Michael Kutner
- Department of Biostatistics & Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Ernest Garcia
- Department of Radiology, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Arshed Quyyumi
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Viola Vaccarino
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Paolo Raggi
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - J. Douglas Bremner
- Department of Radiology, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Department of Psychiatry, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Amit J. Shah
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, United States of America
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21
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Bullock-Palmer RP, Shaw LJ, Gulati M. Emerging misunderstood presentations of cardiovascular disease in young women. Clin Cardiol 2019; 42:476-483. [PMID: 30793342 PMCID: PMC6712330 DOI: 10.1002/clc.23165] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/13/2019] [Accepted: 02/20/2019] [Indexed: 12/14/2022] Open
Abstract
Background Cardiovascular disease (CVD) remains the leading cause of death for females in the United States accounting for over 412 000 female deaths in 2016. CVD mortality in young women <55 years old remains significantly high and greater than that in men. Hypothesis There is a void with regards to awareness of CVD in women. Many traditional CVD risk estimate tools fail to identify the “at risk” female and is true for the young female patient. There needs to be a shift in focus from looking for the vulnerable plaque to looking for the “at risk” patient. Methods This review outlines the emerging misunderstood presentations of CVD in young women which include certain categories of myocardial infarction (MI) with non‐obstructive coronary arteries (MINOCA), such as spontaneous coronary artery dissection (SCAD), as well as the more stable myocardial ischemia with non‐obstructive coronary arteries (INOCA) category focusing on mental stress‐induced myocardial ischemia (MSIMI). Results The prevalence of MINOCA in patients presenting with MI is greater in women. In younger women with CVD, SCAD is an emerging misunderstood presentation in this group of patients with type 2 SCAD being the most common form. MSIMI, a form of INOCA, is more common in women with CVD. Conclusions There are emerging misunderstood factors that are prevalent in young women, such as SCAD and MSIMI. It is important to recognize their presentations in young women to prevent misdiagnosis, missed diagnosis as well as mismanagement of these patients to improve their clinical outcomes.
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Affiliation(s)
| | - Leslee J Shaw
- Department of Radiology, Weill Cornell Medical College, New York, New York
| | - Martha Gulati
- Department of Cardiology, University of Arizona College of Medicine, Phoenix, Arizona
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22
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Bhagra A, Medina-Inojosa JR, Vinnakota S, Arciniegas MC, Garcia M, Sood A, Mahapatra S, Lopez-Jimenez F, Bauer BA, Cha SS, Mulvagh SL. Stress Management and Resilience Intervention in a Women's Heart Clinic: A Pilot Study. J Womens Health (Larchmt) 2019; 28:1705-1710. [PMID: 30907678 DOI: 10.1089/jwh.2018.7216] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: In general, women report higher stress levels than men. High baseline anxiety, depression, and stress levels are associated with greater risk of cardiovascular diseases. Current evidence for efficacy of stress management interventions for women is limited. This study aimed at assessing the effect of a stress management and resiliency training (SMART) program for decreasing stress, anxiety, and depressive symptoms. Methods: Fifty moderately or severely stressed Women's Heart/Preventive Cardiology Clinic patients consented to the SMART intervention delivered online (n = 36) or in-person (n = 9). Primary outcome measures were the observed changes between baseline and at 12 weeks for the following psychometric tools: General Anxiety Disorder-7 (GAD-7), Patient Health Questionnaires (PHQ-9), Perceived Stress Scale (PSS), and Brief Resiliency Scale (BRS). Results: Forty-five patients completed the study. We observed significant improvements in PSS and GAD-7, but not in PHQ-9 or BRS, after the SMART intervention. When assessing outcomes among those with depressive symptoms at baseline (PHQ-9 > 15), we observed significant changes in PSS, GAD-7, and PHQ-9. No differences between online and in-person program delivery methods were found (all p-values >0.05). Conclusions: Training exposure using the SMART program to decrease stress and anxiety in women seeking preventive cardiology services was feasible and similarly effective, whether delivered online or in a single in-person session. Impacts on depression and resilience likely require a more intensive approach. In the future, larger randomized clinical trials with additional training and longer follow-up are warranted.
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Affiliation(s)
- Anjali Bhagra
- Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jose R Medina-Inojosa
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Maria C Arciniegas
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mariana Garcia
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Amit Sood
- Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Saswati Mahapatra
- Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Francisco Lopez-Jimenez
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Brent A Bauer
- Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Stephen S Cha
- Department of Health Science Research, Mayo Clinic, Rochester, Minnesota
| | - Sharon L Mulvagh
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.,Division of Cardiology, Department of Medicine, Queen Elizabeth II Health Sciences Center, Dalhousie University, Halifax, Canada
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23
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Geraiely B, Tavoosi A, Sattarzadeh R, Hassanbeigi H, Larry M. Board examination stress effect on diastolic function. JOURNAL OF CLINICAL ULTRASOUND : JCU 2019; 47:139-143. [PMID: 30421527 DOI: 10.1002/jcu.22665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 09/20/2018] [Accepted: 10/05/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND To this date, effects of mental stress on cardiac function have not been clearly investigated. Although hemodynamic and neuroendocrine adverse effects of daily mental stress on cardiovascular morbidity and mortality have been reported, its direct impact on diastolic function of the heart has not been previously studied. In this study, we aimed to assess the role of Board Exam anxiety on right and left ventricular diastolic function in medical residents. METHODS Forty medical residents prior to participation in the medical board exam were enrolled in our study. Right prior to as well as 2 month after the exam, all residents underwent trans-thoracic Doppler echocardiography. Right ventricular systolic and diastolic functions and echocardiography indices were measured. Levels of anxiety were measured using Beck Anxiety Inventory Questionnaire before and after the exam. Pre exam and post exam results of study population as well as low and high anxiety groups were evaluated. RESULTS Early to late mitral inflow velocity (E/A ratio) in LV inflow increased after board exam (P-value <.001). E/A ratio in RV inflow increased after board exam (P-value: .002). Early mitral inflow to its annular velocity (E/E' ratio) in septal wall decreased after board exam (P-value<.001). The change in E/E' RV free wall did not reach statistical significance (P = .57). Mitral annuls velocities measured by TDI in septal and lateral wall and also tricuspid annulus velocity increased after board exam (P-value<.05). The comparison of these changes between the high-stress and low-stress groups of residents revealed significant differences. Comparison of changes of E/A ratio in the mitral and tricuspid inflow as well as the E/E' in the septum and free wall of the right ventricle before and after the Board Exam between high-stress and low-stress groups was not statistically significant, although there was a trend of more changes in high- stress group residents. CONCLUSION This is the first report of comprehensive sequential assessment of left and right ventricular diastolic functions during and after a real subacute stress occasion. The finding of a decreased E/A and E' in response to mental stress suggests that repetitive mental stress may induce diastolic dysfunction which is a mechanism of diastolic heart failure in individuals at risk.
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Affiliation(s)
- Babak Geraiely
- Cardiology Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Anahita Tavoosi
- Cardiology Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Roya Sattarzadeh
- Cardiology Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Hassanbeigi
- Cardiology Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrdad Larry
- Cardiology Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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Bremner JD, Campanella C, Khan Z, Fani N, Kasher N, Evans S, Reiff C, Mishra S, Ladd S, Nye JA, Raggi P, Vaccarino V. Brain mechanisms of stress and depression in coronary artery disease. J Psychiatr Res 2019; 109:76-88. [PMID: 30508746 PMCID: PMC6317866 DOI: 10.1016/j.jpsychires.2018.11.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 10/24/2018] [Accepted: 11/20/2018] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Major depression is associated with an increased risk for and mortality from coronary artery disease (CAD), however the mechanisms by which this occurs are not clear. Depression, which is linked to stress, is associated with changes in brain areas involved in memory and the stress response, and it is likely that these regions play an important role in this increased risk. This study assessed the effects of stress on brain and cardiac function in patients with CAD with and without depression. METHODS CAD patients with (N = 17) and without (N = 21) major depression based on the Structured Clinical Interview for DSM-IV (DSM-IV) and/or a Hamilton Depression Scale score of nine or greater underwent imaging of the brain with high resolution positron emission tomography (HR-PET) and [O-15] water and imaging of the heart with single photon emission tomography (SPECT) and [Tc-99 m] sestamibi during mental stress (mental arithmetic) and control conditions. RESULTS Patients with CAD and major depression showed increased parietal cortex activation and a relative failure of medial prefrontal/anterior cingulate activation during mental stress compared to CAD patients without depression. Depressed CAD patients with stress-induced myocardial ischemia, however, when compared to depressed CAD patients without showed increased activation in rostral portions of the anterior cingulate. CONCLUSIONS These findings are consistent with a role for brain areas implicated in stress and depression in the mechanism of increased risk for CAD morbidity and mortality in CAD patients with the diagnosis of major depression.
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Affiliation(s)
- J Douglas Bremner
- Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA; Department of Radiology, and Internal Medicine (Cardiology), Emory University School of Medicine, Atlanta, GA, USA; Atlanta VA Medical Center, Decatur, GA, USA.
| | | | - Zehra Khan
- Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA
| | - Negar Fani
- Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA
| | - Nicole Kasher
- Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA
| | - Sarah Evans
- Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA
| | - Collin Reiff
- Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA
| | - Sanskriti Mishra
- Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA
| | - Stacy Ladd
- Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA
| | - Jonathon A Nye
- Department of Radiology, and Internal Medicine (Cardiology), Emory University School of Medicine, Atlanta, GA, USA
| | - Paolo Raggi
- Mazankowski Alberta Heart Institute and the Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Viola Vaccarino
- Department of Internal Medicine (Cardiology), Emory University School of Medicine, Atlanta, GA, USA; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Sex-Specific Association Between Coronary Artery Disease Severity and Myocardial Ischemia Induced by Mental Stress. Psychosom Med 2019; 81:57-66. [PMID: 30571661 PMCID: PMC6800112 DOI: 10.1097/psy.0000000000000636] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE It is unclear whether mental stress-induced myocardial ischemia (MSIMI) is related to obstructive coronary artery disease (CAD). We examined this question and contrasted results with ischemia induced by conventional stress testing (CSIMI). Because women are more susceptible to ischemia without coronary obstruction than men, we examined sex differences. METHODS We studied 276 patients 61 years and younger with recent myocardial infarction. CAD severity was quantified using the log-transformed Gensini Score (lnGS) and the Sullivan Stenosis Score. Patients underwent myocardial perfusion imaging with mental stress (public speaking) and conventional (exercise or pharmacological) stress testing. MSIMI and CSIMI were defined as a new or worsening perfusion defect. RESULTS The prevalence of MSIMI was 15% in men and 20% in women. The median GS for patients with MSIMI was 65.0 in men and 28.5 in women. In logistic regression models adjusted for demographic and cardiovascular risk factors, CAD severity was associated with CSIMI in the full sample (odds ratio [OR] = 1.49, 95% [CI], 1.14-1.95, per 1-unit increase in lnGS), with no significant difference by sex. Although CAD severity was not associated with MSIMI in the entire sample, results differed by sex. CAD severity was associated with MSIMI among men (OR = 1.95, 95% CI, 1.13-3.36, per 1-unit increase in lnGS), but not among women (OR = 1.02, 95% CI, 0.74-1.42, p = .042 for interaction). Analysis using Sullivan Stenosis Score yielded similar results. CONCLUSIONS Findings suggest that CAD severity is related to MSIMI in men but not women. MSIMI in women may therefore be driven by alternative mechanisms such as coronary microvascular disease.
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Medina-Inojosa JR, Vinnakota S, Garcia M, Arciniegas Calle M, Mulvagh SL, Lopez-Jimenez F, Bhagra A. Role of Stress and Psychosocial Determinants on Women's Cardiovascular Risk and Disease Development. J Womens Health (Larchmt) 2018; 28:483-489. [PMID: 30457922 DOI: 10.1089/jwh.2018.7035] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
The notion that cardiovascular disease (CVD) primarily occurs in men is slowly disappearing. More women than men die of CVD every year, and when women survive, the burden and consequences are worse than in men. Markers of stress and other psychosocial factors have been associated with poor outcomes. Multiple studies have demonstrated sex-based differences in the vascular and endothelial responses to mental stress. Psychosocial stressors were also found to be independent risk factors for the development and progression of CVD. This review arises from accumulating evidence suggesting that psychological well-being may improve cardiac-related outcomes, independent of cardiac risk factors. Despite the fact that positive physician-patient engagement is likely to play a critical role in promoting positive psychological traits and healthy behaviors, current physician awareness and advocacy are rather suboptimal, despite active awareness campaigns such as the American Heart Association's Go Red for Women®. There is a need to further study the role and management of stress as a CVD risk factor, especially in women, who are disproportionately affected.
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Affiliation(s)
- Jose R Medina-Inojosa
- 1 Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Shravya Vinnakota
- 2 Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mariana Garcia
- 1 Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Maria Arciniegas Calle
- 1 Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sharon L Mulvagh
- 1 Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.,3 Division of Cardiology, Nova Scotia Health Authority, Dalhousie University, Halifax, Canada
| | - Francisco Lopez-Jimenez
- 1 Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Anjali Bhagra
- 2 Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
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Luo Y, Zhang S, Zheng R, Xu L, Wu J. Effects of depression on heart rate variability in elderly patients with stable coronary artery disease. J Evid Based Med 2018; 11:242-245. [PMID: 30094948 DOI: 10.1111/jebm.12310] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 06/01/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Depression is an independent risk factor in coronary artery disease (CAD). Our objective was to evaluate the impact of depression on heart rate variability (HRV) in patients with stable CAD. METHODS This study included patients with a stable CAD who admitted to our hospital in the geriatric medical center from August 2016 to December 2016. All patients agreed to participate in the study and sign informed consent. The study group included 90 CAD patients with a diagnosis of depression and 99 CAD patients without depression. All study population underwent a 24-hour Holter recording for HRV. The depression was assessed by 5-Item Geriatric Depression. RESULTS There was a linear correlation between age and HRV. There were no significant differences in heart rate variability between male and female patients, married and unmarried/widowed, smoking and nonsmoking, drinking and nondrinking groups. Multiple linear regression analysis showed that there were correlations between depression and HRV. β-blockers were associated with SDNN, SDANN, SDNN index, and RMSSD in HRV. CONCLUSION Depression is an important risk factor for heart rate variability in elderly patients with CAD. Clinicians should pay attention for evaluation of depressive patients with CAD.
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Affiliation(s)
- Ying Luo
- Department of VIP Healthcare Management, West China Hospital, Sichuan University
| | - Shaomin Zhang
- Department of Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Rongrong Zheng
- Department of Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Lian Xu
- Department of Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Jinhui Wu
- Department of Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
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Spicer J, Shimbo D, Johnston N, Harlapur M, Purdie-Vaughns V, Cook J, Fu J, Burg MM, Wager TD. Prevention of Stress-Provoked Endothelial Injury by Values Affirmation: a Proof of Principle Study. Ann Behav Med 2018; 50:471-9. [PMID: 26608279 DOI: 10.1007/s12160-015-9756-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Julie Spicer
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Daichi Shimbo
- Department of Medicine, Columbia University, New York, NY, USA
| | - Natalie Johnston
- Department of Psychology, Columbia University, New York, NY, USA
| | | | | | - Jonathan Cook
- Department of Psychology, Columbia University, New York, NY, USA
| | - Jie Fu
- Department of Medicine, Columbia University, New York, NY, USA
| | - Matthew M Burg
- Department of Medicine, Columbia University, New York, NY, USA
| | - Tor D Wager
- Department of Psychology and Neuroscience, University of Colorado, 345 UCB, Boulder, CO, 80305, USA.
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King JC, Rosen SD, Nixon PG. Failure of Perception of Hypocapnia: Physiological and Clinical Implications. J R Soc Med 2018; 83:765-7. [PMID: 2125316 PMCID: PMC1292948 DOI: 10.1177/014107689008301205] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Hyperventilation causes hypocapnia and respiratory alkalosis and thereby predisposes to coronary vasoconstriction and cardiac arrhythmia. Diagnostic methods for use between episodes have not been established. In this study of 100 patients and 25 control subjects the resting end-tidal PCO2 (Pet CO2) levels and the results of a forced hyperventilation test did not show a significant difference between the groups. However the patients hyperventilated more profoundly in response to emotional stimulation, and were less aware of inappropriate breathing and hypocapnia. It is suggested that these differences should be accommodated in cardiac rehabilitation.
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Affiliation(s)
- J C King
- Department of Cardiology, Charing Cross Hospital, London
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30
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Dal Lin C, Tona F, Osto E. The Heart as a Psychoneuroendocrine and Immunoregulatory Organ. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1065:225-239. [PMID: 30051388 DOI: 10.1007/978-3-319-77932-4_15] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The heart can be viewed not just as muscle pump but also as an important checkpoint for a complex network of nervous, endocrine, and immune signals. The heart is able to process neurological signals independently from the brain and to crosstalk with the endocrine and immune systems. The heart communicates with the psyche through the neuro-endocrine-immune system in a highly integrated way, in order to maintain the homeostasis of the whole body with peculiarities specific to males and females.
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Affiliation(s)
- Carlo Dal Lin
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Francesco Tona
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Elena Osto
- Laboratory of Translational Nutrition Biology, Federal Institute of Technology Zurich ETHZ, Zurich, Switzerland. .,Center for Molecular Cardiology, University of Zurich and University Heart Center, Cardiology, University Hospital Zurich, Zurich, Switzerland.
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Mehta PK, Hermel M, Nelson MD, Cook-Wiens G, Martin EA, Alkhoder AA, Wei J, Minissian M, Shufelt CL, Marpuri S, Hermel D, Shah A, Irwin MR, Krantz DS, Lerman A, Noel Bairey Merz C. Mental stress peripheral vascular reactivity is elevated in women with coronary vascular dysfunction: Results from the NHLBI-sponsored Cardiac Autonomic Nervous System (CANS) study. Int J Cardiol 2017; 251:8-13. [PMID: 29103858 DOI: 10.1016/j.ijcard.2017.10.061] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 09/26/2017] [Accepted: 10/17/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Women with chest pain, ischemia, and no obstructive coronary artery disease often have coronary vascular dysfunction (CVaD). Peripheral vascular reactivity to mental stress may contribute mechanistic understanding of stress-induced ischemia in women with CVaD. METHODS 62 women (41 CVaD and 21 controls) underwent mental stress testing (MST) with anger recall, mental arithmetic, and forehead cold pressor (COP) challenge. Emotional arousal was measured (Likert scale). Reactive hyperemia index (RHI) was calculated before and after MST by peripheral arterial tonometry (PAT). Stress PAT ratio (SPR) of pulse amplitude during stress to rest was obtained to measure vasoconstriction. Wilcoxson rank sum test was used for analysis. RESULTS Mean age of CVaD and control groups was 58±9 and 55±10years (p=0.73). Baseline RHI correlated with coronary endothelial function (r=0.36, p=0.03) and inversely with RHI change post-MST (r=-0.51, p<0.001). During MST, 10% of controls reported chest pain vs. 41% of CVaD subjects (p=0.01). RHI did not change significantly after MST in either group. CVaD subjects had lower SPR vs. controls during mental arithmetic (0.54 [0.15, 1.46] vs. 0.67 [0.36, 1.8], p=0.039), not evident in the other tasks. Vasoconstriction inversely correlated with anxiety (r=-3.4, p=0.03), frustration (r=-0.37, p=0.02), and feeling challenged (r=-0.37, p=0.02) in CVaD but not controls. CONCLUSIONS Mental stress peripheral vascular reactivity is elevated in women with CVaD compared to controls. Elevated vascular reactivity may be one contributor to stress-induced chest pain in CVaD. Interventions that modulate vasoconstrictive responses may be of benefit and should be tested in clinical trials in women with CVaD.
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Affiliation(s)
- Puja K Mehta
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, United States.
| | - Melody Hermel
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, United States
| | - Michael D Nelson
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, United States
| | - Galen Cook-Wiens
- Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Elizabeth A Martin
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, United States
| | - Ayman A Alkhoder
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, United States
| | - Janet Wei
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, United States
| | - Margo Minissian
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, United States
| | - Chrisandra L Shufelt
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, United States
| | - Sailaja Marpuri
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, United States
| | - David Hermel
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, United States
| | - Amit Shah
- Department of Epidemiology, Rollins School of Public Health, Emory University, United States
| | - Michael R Irwin
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience, David Geffen SOM at UCLA, United States
| | - David S Krantz
- Department of Medical and Clinical Psychology, Uniformed Services University, Bethesda, MD, United States
| | - Amir Lerman
- Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, United States
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Sherwood A, Hill LK, Blumenthal JA, Adams KF, Paine NJ, Koch GG, O'Connor CM, Johnson KS, Hinderliter AL. Blood pressure reactivity to psychological stress is associated with clinical outcomes in patients with heart failure. Am Heart J 2017; 191:82-90. [PMID: 28888274 DOI: 10.1016/j.ahj.2017.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 07/07/2017] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Cardiovascular (CV) reactivity to psychological stress has been implicated in the development and exacerbation of cardiovascular disease (CVD). Although high CV reactivity traditionally is thought to convey greater risk of CVD, the relationship between reactivity and clinical outcomes is inconsistent and may depend on the patient population under investigation. The present study examined CV reactivity in patients with heart failure (HF) and its potential association with long-term clinical outcomes. METHODS One hundred ninety-nine outpatients diagnosed with HF, with ejection fraction ≤40%, underwent an evaluation of blood pressure (BP) and heart rate reactivity to a laboratory-based simulated public-speaking stressor. Cox proportional hazards regression models were used to examine the prospective association between BP and heart rate reactivity on a combined end point of death or CV hospitalization over a 5-year median follow-up period. RESULTS Both systolic blood pressure (SBP) and diastolic blood pressure (DBP) reactivity, quantified as continuous variables, were inversely related to risk of death or CV hospitalization (Ps < .01) after controlling for established risk factors, including HF disease severity and etiology. In similar models, heart rate reactivity was unrelated to outcome (P = .12). In models with tertiles of reactivity, high SBP reactivity, compared with intermediate SBP reactivity, was associated with lower risk (hazard ratio [HR] = .498, 95% CI .335-.742, P =.001), whereas low SBP reactivity did not differ from intermediate reactivity. For DBP, high reactivity was marginally associated with lower risk compared with intermediate DBP reactivity (HR = .767, 95% CI .515-1.14, P =.193), whereas low DBP reactivity was associated with greater risk (HR = 1.49, 95% CI 1.027-2.155, P =.0359). No relationship of heart rate reactivity to outcome was identified. CONCLUSIONS For HF patients with reduced ejection fraction, a robust increase in BP evoked by a laboratory-based psychological challenge was associated with lower risk for adverse CVD events and may be a novel and unique marker of left ventricular systolic reserve that is accompanied by a more favorable long-term prognosis.
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Affiliation(s)
| | | | | | - Kirkwood F Adams
- University of North Carolina School of Medicine, Chapel Hill, NC
| | | | - Gary G Koch
- University of North Carolina School of Public Health, Chapel Hill, NC
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Yaribeygi H, Panahi Y, Sahraei H, Johnston TP, Sahebkar A. The impact of stress on body function: A review. EXCLI JOURNAL 2017; 16:1057-1072. [PMID: 28900385 PMCID: PMC5579396 DOI: 10.17179/excli2017-480] [Citation(s) in RCA: 216] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 07/18/2017] [Indexed: 12/19/2022]
Abstract
Any intrinsic or extrinsic stimulus that evokes a biological response is known as stress. The compensatory responses to these stresses are known as stress responses. Based on the type, timing and severity of the applied stimulus, stress can exert various actions on the body ranging from alterations in homeostasis to life-threatening effects and death. In many cases, the pathophysiological complications of disease arise from stress and the subjects exposed to stress, e.g. those that work or live in stressful environments, have a higher likelihood of many disorders. Stress can be either a triggering or aggravating factor for many diseases and pathological conditions. In this study, we have reviewed some of the major effects of stress on the primary physiological systems of humans.
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Affiliation(s)
- Habib Yaribeygi
- Neurosciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Yunes Panahi
- Clinical Pharmacy Department, Faculty of Pharmacy, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hedayat Sahraei
- Neurosciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Thomas P Johnston
- Division of Pharmaceutical Sciences, School of Pharmacy, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Haaf P, Ritter M, Grize L, Pfisterer ME, Zellweger MJ. Quality of life as predictor for the development of cardiac ischemia in high-risk asymptomatic diabetic patients. J Nucl Cardiol 2017; 24:772-782. [PMID: 28091969 DOI: 10.1007/s12350-016-0759-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 07/01/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Ischemia induced by psychological stress and depression is a common phenomenon in stable coronary artery disease (CAD). We evaluated the quality of life (QoL) of diabetic patients screened for CAD and assessed the prognostic value of mental and physical QoL scores to predict the development of new cardiac ischemia. METHODS Prospective multicentre outcome study. The study comprised 400 asymptomatic diabetic patients without history or symptoms of CAD. They underwent myocardial perfusion single-photon emission computed tomography (MPS) and assessment of QoL by two questionnaires: Hospital Depression and Anxiety Scale (HADS-D and HADS-A) and Medical Outcomes Study Short Form 36 (SF-36) at baseline and after 2 years. Patients with normal MPS received usual care; those with abnormal MPS received medical or combined invasive and medical management. RESULTS Only mental QoL scores but not physical QoL scores or traditional cardiovascular risk factors were predictive of new ischemia (n = 11/306) during follow-up. The prognostic value for new ischemia as quantified by the area under the receiver operating characteristics curve (AUC) amounted to 0.784 (95% confidence interval (CI) 0.654-0.914, P = 0.002) for HADS-D and to 0.737 (95% CI 0.580-0.893, P = 0.011) for HADS-A. This finding was confirmed by SF-36 mental sum score (AUC 0.688, 95% CI 0.539-0.836, P = 0.036), but not SF-36 physical sum score. QoL scores did not change after 2 years in patients with ischemia at baseline. CONCLUSIONS QoL scores assessing mental health, particularly depression and anxiety, predicted the development of new cardiac ischemia in asymptomatic diabetic patients. The study is limited by a small number of events (new ischemia) and so the results should be considered hypothesis generating rather than conclusive.
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Affiliation(s)
- Philip Haaf
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Myriam Ritter
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Leticia Grize
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - Matthias E Pfisterer
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Michael J Zellweger
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland.
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Heine T, Lenis G, Reichensperger P, Beran T, Doessel O, Deml B. Electrocardiographic features for the measurement of drivers' mental workload. APPLIED ERGONOMICS 2017; 61:31-43. [PMID: 28237018 DOI: 10.1016/j.apergo.2016.12.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 11/26/2016] [Accepted: 12/21/2016] [Indexed: 06/06/2023]
Abstract
This study examines the effect of mental workload on the electrocardiogram (ECG) of participants driving the Lane Change Task (LCT). Different levels of mental workload were induced by a secondary task (n-back task) with three levels of difficulty. Subjective data showed a significant increase of the experienced workload over all three levels. An exploratory approach was chosen to extract a large number of rhythmical and morphological features from the ECG signal thereby identifying those which differentiated best between the levels of mental workload. No single rhythmical or morphological feature was able to differentiate between all three levels. A group of parameters were extracted which were at least able to discriminate between two levels. For future research, a combination of features is recommended to achieve best diagnosticity for different levels of mental workload.
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Affiliation(s)
- Tobias Heine
- Institute of Human and Industrial Engineering (ifab), Karlsruhe Institute of Technology (KIT), Kaiserstrasse 12, 76131 Karlsruhe, Germany.
| | - Gustavo Lenis
- Institute of Biomedical Engineering (IBT), Karlsruhe Institute of Technology (KIT), Fritz-Haber-Weg 1, 76131 Karlsruhe, Germany
| | - Patrick Reichensperger
- Institute of Biomedical Engineering (IBT), Karlsruhe Institute of Technology (KIT), Fritz-Haber-Weg 1, 76131 Karlsruhe, Germany
| | - Tobias Beran
- Institute of Human and Industrial Engineering (ifab), Karlsruhe Institute of Technology (KIT), Kaiserstrasse 12, 76131 Karlsruhe, Germany
| | - Olaf Doessel
- Institute of Biomedical Engineering (IBT), Karlsruhe Institute of Technology (KIT), Fritz-Haber-Weg 1, 76131 Karlsruhe, Germany
| | - Barbara Deml
- Institute of Human and Industrial Engineering (ifab), Karlsruhe Institute of Technology (KIT), Kaiserstrasse 12, 76131 Karlsruhe, Germany
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Mental Stress, Exercise, and Other Determinants of Elevation in High-Sensitivity Troponin Levels: A Call for Standardization of Laboratory Protocols. JACC Cardiovasc Imaging 2017; 11:612-615. [PMID: 28330668 DOI: 10.1016/j.jcmg.2017.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 01/19/2017] [Indexed: 11/20/2022]
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Puzserova A, Bernatova I. Blood pressure regulation in stress: focus on nitric oxide-dependent mechanisms. Physiol Res 2017; 65:S309-S342. [PMID: 27775419 DOI: 10.33549/physiolres.933442] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Stress is considered a risk factor associated with the development of various civilization diseases including cardiovascular diseases, malignant tumors and mental disorders. Research investigating mechanisms involved in stress-induced hypertension have attracted much attention of physicians and researchers, however, there are still ambiguous results concerning a causal relationship between stress and long-term elevation of blood pressure (BP). Several studies have observed that mechanisms involved in the development of stress-induced hypertension include increased activity of sympathetic nervous system (SNS), glucocorticoid (GC) overload and altered endothelial function including decreased nitric oxide (NO) bioavailability. Nitric oxide is well known neurotransmitter, neuromodulator and vasodilator involved in regulation of neuroendocrine mechanisms and cardiovascular responses to stressors. Thus NO plays a crucial role in the regulation of the stress systems and thereby in the BP regulation in stress. Elevated NO synthesis, especially in the initial phase of stress, may be considered a stress-limiting mechanism, facilitating the recovery from stress to the resting levels via attenuation of both GC release and SNS activity as well as by increased NO-dependent vasorelaxation. On the other hand, reduced levels of NO were observed in the later phases of stress and in subjects with genetic predisposition to hypertension, irrespectively, in which reduced NO bioavailability may account for disruption of NO-mediated BP regulatory mechanisms and accentuated SNS and GC effects. This review summarizes current knowledge on the role of stress in development of hypertension with a special focus on the interactions among NO and other biological systems affecting blood pressure and vascular function.
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Affiliation(s)
- A Puzserova
- Institute of Normal and Pathological Physiology, Slovak Academy of Sciences, Bratislava, Slovak Republic.
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Anxiety and anger immediately prior to myocardial infarction and long-term mortality: Characteristics of high-risk patients. J Psychosom Res 2017; 93:19-27. [PMID: 28107888 PMCID: PMC5260840 DOI: 10.1016/j.jpsychores.2016.12.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 11/22/2016] [Accepted: 12/01/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Acute high levels of anger and anxiety are associated with an elevated risk of myocardial infarction (MI) in the following two hours. MIs preceded by these acute negative emotions may also have a poor long-term prognosis, but information about high-risk patients is lacking. We examined whether young age and female sex are associated with MIs that are preceded by negative emotions and whether age and sex moderate the subsequent increased mortality risk following MI preceded by negative emotions. METHODS We conducted a secondary analysis of the Determinants of Myocardial Infarction Onset Study (N=2176, mean age=60.1±12.3years, 29.2% women). Anxiety and anger immediately prior to (0-2h) MI and the day before (24-26h) MI were assessed using a structured interview. Subsequent 10-year all-cause mortality was determined using the US National Death Index. RESULTS Anxiety during the 0-2h pre-MI period was associated with younger age (OR=0.98,95% CI=0.96-0.99 per year) and female sex (OR=1.50,95% CI=1.11-2.02). Anger in the 0-2h pre-MI period was also associated with younger age (OR=0.95,95% CI=0.94-0.96) but not with sex (OR=0.93,95% CI=0.67-1.28). During follow-up, 580 (26.7%) patients died. Mortality rate was higher if MI occurred immediately after high anxiety, particularly in patients ≥65years (HR=1.80,95% CI=1.28-2.54) vs. younger patients (HR=0.87,95% CI=0.55-1.40; p-interaction=0.015). Other interactions with sex or anger were not significant. CONCLUSIONS Patients with high anxiety or anger levels in the critical 2-hour period prior to MI are younger than those without such emotional precipitants. In addition, pre-MI anxiety is associated with an elevated 10-year mortality risk in patients aged ≥65years.
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Aydin Sunbul E, Sunbul M, Gulec H. The impact of major depression on heart rate variability and endothelial dysfunction in patients with stable coronary artery disease. Gen Hosp Psychiatry 2017; 44:4-9. [PMID: 28041575 DOI: 10.1016/j.genhosppsych.2016.10.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 10/17/2016] [Accepted: 10/24/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Depression is an independent risk factor in cardiovascular diseases. Changes in the cardiac autonomic functions and pro-inflammatory processes are potential biological factors. Endothelial dysfunction plays an important role in the etiopathogenesis of atherosclerosis. Our objective was to evaluate the impact of major depression on heart rate variability and endothelial dysfunction in patients with stable CAD. METHODS The study group included 65 CAD patients with a diagnosis of major depression and 54 CAD patients without major depression. All study population underwent transthoracic echocardiography, measurement of flow mediated dilatation (FMD) and 24-h holter recording for heart rate variability (HRV). Blood samples were drawn to determine the inflammatory parameters. Severity of depressive episode was assessed by Montgomery-Asberg Depression Scale (MADRS). RESULTS The distribution of age and sex was similar in the patient and control groups (P=0.715, 0.354, respectively). There was no significant difference in medications used between the groups. Echocardiographic parameters were similar between the groups. Inflammatory parameters were also similar between the groups. HRV parameters were significantly lower in the patient group than controls. The absolute FMD value and percentage FMD were significantly lower in the patient group than controls (P<0.001). The MADRS score correlated with pNN50 in both groups (P<0.05), and with FMD in the control group (P<0.001), even after adjusting for age and gender (P<0.001). CONCLUSIONS MADRS score was an independent predictor of pNN50 level, percentage and absolute FMD values regardless of age and gender. Clinician should pay more attention for evaluation of depressive patients with CAD.
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Affiliation(s)
- Esra Aydin Sunbul
- Erenkoy Training and Research Hospital for Psychiatric and Neurological Disorders, Psychiatry Clinic, Istanbul, Turkey
| | - Murat Sunbul
- Marmara University Faculty of Medicine, Department of Cardiology, Istanbul, Turkey.
| | - Huseyin Gulec
- Erenkoy Training and Research Hospital for Psychiatric and Neurological Disorders, Psychiatry Clinic, Istanbul, Turkey
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Sunbul M, Zincir SB, Durmus E, Sunbul EA, Cengiz FF, Kivrak T, Samadov F, Sari I. Anxiety and Depression in Patients with Coronary Artery Disease. ACTA ACUST UNITED AC 2016. [DOI: 10.5455/bcp.20130421014758] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Murat Sunbul
- M.D., Marmara University Faculty of Medicine, Department of Cardiology, Istanbul - Turkey
- M.D., Erenkoy Training and Research Hospital for Psychiatric and Neurological Disorders, Psychiatry Clinic, Istanbul - Turkey
- Assoc. Prof., Marmara University Faculty of Medicine, Department of Cardiology, Istanbul - Turkey
| | - Selma Bozkurt Zincir
- M.D., Marmara University Faculty of Medicine, Department of Cardiology, Istanbul - Turkey
- M.D., Erenkoy Training and Research Hospital for Psychiatric and Neurological Disorders, Psychiatry Clinic, Istanbul - Turkey
- Assoc. Prof., Marmara University Faculty of Medicine, Department of Cardiology, Istanbul - Turkey
| | - Erdal Durmus
- M.D., Marmara University Faculty of Medicine, Department of Cardiology, Istanbul - Turkey
- M.D., Erenkoy Training and Research Hospital for Psychiatric and Neurological Disorders, Psychiatry Clinic, Istanbul - Turkey
- Assoc. Prof., Marmara University Faculty of Medicine, Department of Cardiology, Istanbul - Turkey
| | - Esra Aydin Sunbul
- M.D., Marmara University Faculty of Medicine, Department of Cardiology, Istanbul - Turkey
- M.D., Erenkoy Training and Research Hospital for Psychiatric and Neurological Disorders, Psychiatry Clinic, Istanbul - Turkey
- Assoc. Prof., Marmara University Faculty of Medicine, Department of Cardiology, Istanbul - Turkey
| | - Fatma Fariha Cengiz
- M.D., Marmara University Faculty of Medicine, Department of Cardiology, Istanbul - Turkey
- M.D., Erenkoy Training and Research Hospital for Psychiatric and Neurological Disorders, Psychiatry Clinic, Istanbul - Turkey
- Assoc. Prof., Marmara University Faculty of Medicine, Department of Cardiology, Istanbul - Turkey
| | - Tarik Kivrak
- M.D., Marmara University Faculty of Medicine, Department of Cardiology, Istanbul - Turkey
- M.D., Erenkoy Training and Research Hospital for Psychiatric and Neurological Disorders, Psychiatry Clinic, Istanbul - Turkey
- Assoc. Prof., Marmara University Faculty of Medicine, Department of Cardiology, Istanbul - Turkey
| | - Fuad Samadov
- M.D., Marmara University Faculty of Medicine, Department of Cardiology, Istanbul - Turkey
- M.D., Erenkoy Training and Research Hospital for Psychiatric and Neurological Disorders, Psychiatry Clinic, Istanbul - Turkey
- Assoc. Prof., Marmara University Faculty of Medicine, Department of Cardiology, Istanbul - Turkey
| | - Ibrahim Sari
- M.D., Marmara University Faculty of Medicine, Department of Cardiology, Istanbul - Turkey
- M.D., Erenkoy Training and Research Hospital for Psychiatric and Neurological Disorders, Psychiatry Clinic, Istanbul - Turkey
- Assoc. Prof., Marmara University Faculty of Medicine, Department of Cardiology, Istanbul - Turkey
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Sarabi M, Lind L. Mental stress opposes endothelium-dependent vasodilation in young healthy individuals. Vasc Med 2016. [DOI: 10.1177/1358836x0100600102] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mental stress has been shown to induce myocardial ischemia in people with coronary heart disease (CHD), both in the laboratory and in daily life. In order to investigate the role of the endothelium in the regulation of blood flow during stress, the endothelium-dependent (EDV) and endothelium-independent (EIDV) vasodilation was examined in the forearms of healthy people during a mental arithmetic test (MAT), a cold pressor test (CP) and an isometric handgrip test (ISO). A total of 10 young healthy volunteers (four men and six women, aged 20-25 years) underwent measurements of forearm vascular resistance (FVR) during local intra-arterial infusions of methacholine (MCh; inducing EDV) and sodium nitroprusside (SNP; inducing EIDV) at rest and during the different forms of stress by the use of venous occlusion plethysmography. MAT induced a significant increase in FVR during MCh infusion (4 mg/min, from 3.5 6 0.7 at rest to 4.2 6 1.4 mmHg/ml per min per 100 ml tissue during MAT; p, 0.01), while FVR during SNP infusion was unchanged by MAT. CP induced a significant increase in FVR during infusions with both MCh and SNP compared to resting levels (p, 0.01 for both), while ISO induced a significant increase in FVR during MCh infusion (p, 0.05) and a smaller increase in FVR during SNP infusion. When the SNP to MCh FVR ratio was used as an index of endothelial function, only MAT impaired endothelial function significantly (p, 0.01). In conclusion, mental stress induced by an arithmetic task selectively opposed EDV in the forearms of young healthy people, while cold pressor and isometric handgrip tests induced a more general attenuation in vasodilatation.
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Affiliation(s)
- Mahziar Sarabi
- Department of Internal Medicine, University Hospital of Uppsala, Sweden
| | - Lars Lind
- Department of Internal Medicine, University Hospital of Uppsala, Sweden,
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Taggart P, Critchley H, van Duijvendoden S, Lambiase PD. Significance of neuro-cardiac control mechanisms governed by higher regions of the brain. Auton Neurosci 2016; 199:54-65. [DOI: 10.1016/j.autneu.2016.08.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 08/19/2016] [Accepted: 08/20/2016] [Indexed: 12/24/2022]
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Abstract
Mental stress and emotional arousal can act as triggers of acute myocardial infarction and other adverse cardiovascular outcomes. Experimental research examining mechanisms of the adverse interplay between mind and heart has led to the discovery of mental stress-induced cardiac dysfunction or myocardial ischemia (MSIMI). Evidence about the prevalence, clinical significance, and mechanistic bases of MSIMI outlines a wide range of central and peripheral bio-pathologic processes that are associated with emotions and behaviors. MSIMI is recognized as an integrated and intermediate biomarker underpinning the negative mind-heart interplay. Particularly, MSIMI research paves the way toward investigations aiming more specifically at recognizing the susceptibilities of individuals who are prone to respond adversely to the psycho-social-environmental stress. This article reviews recent literature on MSIMI research following the comprehensive review of Strike and Steptoe Eur Heart J 24:690-703, 2003. Further, this article outlines the main steps in the identification of the specific bio-pathologic manifestations of the cardiovascular system to emotional stress. Finally, a speculative description is provided of future directions in better searching for areas that may be critical targets in resolving adverse mind-heart interplays.
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Affiliation(s)
- Wei Jiang
- Duke University Medical Center, Box 3366, Durham, NC, 27710, USA,
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Endrighi R, Waters AJ, Gottlieb SS, Harris KM, Wawrzyniak AJ, Bekkouche NS, Li Y, Kop WJ, Krantz DS. Psychological stress and short-term hospitalisations or death in patients with heart failure. Heart 2016; 102:1820-1825. [PMID: 27357124 DOI: 10.1136/heartjnl-2015-309154] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 05/31/2016] [Accepted: 06/01/2016] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Standard predictors do not fully explain variations in the frequency and timing of heart failure (HF) adverse events (AEs). Psychological stress can trigger acute cardiovascular (CV) events, but it is not known whether stress can precipitate AEs in patients with HF. We investigated prospective associations of psychological stress with AEs in patients with HF. METHODS 144 patients with HF (77% male; 57.5±11.5, range 23-87 years, left ventricular ejection fraction ≤40%) were longitudinally evaluated for psychological stress (Perceived Stress Scale) and AEs (CV hospitalisations/death) at 2-week intervals for 3 months and at 9-month follow-up. RESULTS 42 patients (29.2%) had at least one CV hospitalisation and nine (6.3%) died. Patients reporting high average perceived stress across study measurements had a higher likelihood of AEs during the study period compared with those with lower stress (odds ratio=1.10, 95% confidence interval=1.04 to 1.17). In contrast to average levels, increases in stress did not predict AEs (p=0.96). Perceived stress was elevated after a CV hospitalisation (B=2.70, standard error (SE)=0.93, p=0.004) suggesting that CV hospitalisations increase stress. Subsequent analysis indicated that 24 of 38 (63%) patients showed a stress increase following hospitalisation. However, a prospective association between stress and AEs was present when accounting for prior hospitalisations (B=2.43, SE=1.23, p=0.05). CONCLUSIONS Sustained levels of perceived stress are associated with increased risk of AEs, and increased distress following hospitalisation occurs in many, but not all, patients with HF. Patients with chronically high stress may be an important target group for HF interventions aimed at reducing hospitalisations.
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Affiliation(s)
- Romano Endrighi
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Division of Behavioral Science Research, Department of Health Policy and Health Services Research, Boston University, Boston, Massachusetts, USA
| | - Andrew J Waters
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | | | - Kristie M Harris
- Cardiopulmonary Behavioral Medicine Laboratory, The Ohio State University, Columbus, Ohio, USA
| | - Andrew J Wawrzyniak
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, Florida, USA
| | - Nadine S Bekkouche
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Yisheng Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Willem J Kop
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - David S Krantz
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Taylor-Piliae RE, Chair SY. The Effect of Nursing Interventions Utilizing Music Therapy or Sensory Information on Chinese Patients’ Anxiety Prior to Cardiac Catheterization: A Pilot Study. Eur J Cardiovasc Nurs 2016; 1:203-11. [PMID: 14622675 DOI: 10.1016/s1474-5151(02)00037-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: Unrelieved anxiety can produce an increase in sympathetic nervous system activity leading to an increase in cardiac workload. Nursing interventions using music therapy or sensory information among patients with coronary artery disease has resulted in anxiety reduction, though results in Chinese subjects has not previously been published. Aims: To determine the effects of using nursing interventions of music therapy or sensory information, on reducing anxiety and uncertainty, and improving negative mood among Chinese subjects immediately prior to cardiac catheterization. Methods: An experimental three-group repeated measures design for this pilot study was used. Forty-five hospitalized adults (15/group) undergoing cardiac catheterization were randomly assigned to either (1) a music therapy intervention, (2) a sensory information intervention or (3) treatment as usual (control). Anxiety, uncertainty and mood state were measured using self-reported questionnaires and physiological measures were made at baseline, post-intervention to determine their effect and post-cardiac catheterization to determine whether these interventions had any long-lasting effect. Results: The control group was found to be significantly older ( P=0.001) than the two experimental groups. Older age was associated with lower anxiety scores ( r=−0.31, P=0.04 at baseline; r=−0.30, P=0.04 post-intervention; r=−0.22, P=0.15 post-cardiac catheterization). After controlling for age, the use of music therapy or sensory information did not significantly reduce anxiety, improve mood state, reduce uncertainty, decrease heart or respiratory rate among subjects undergoing cardiac catheterization. Conclusion: The non-significant result may have been affected by the small sample, and the social and cultural expectations regarding the public display of emotions among Chinese populations.
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Affiliation(s)
- Ruth E Taylor-Piliae
- Department of Physiological Nursing, School of Nursing, University of California, 2 Koret Way, Box 0610, San Francisco, CA 94143-0610, USA.
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Soufer R, Fernandez AB, Meadows J, Collins D, Burg MM. Body Mass Index and Risk for Mental Stress Induced Ischemia in Coronary Artery Disease. Mol Med 2016; 22:286-291. [PMID: 27261777 DOI: 10.2119/molmed.2016.00128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 05/12/2016] [Indexed: 11/06/2022] Open
Abstract
Acute emotionally reactive mental stress (MS) can provoke prognostically relevant deficits in cardiac function and myocardial perfusion, and chronic inflammation increases risk for this ischemic phenomenon. We have described parasympathetic withdrawal and generation of inflammatory factors in MS. Adiposity is also associated with elevated markers of chronic inflammation. High body mass index (BMI) is frequently used as a surrogate for assessment of excess adiposity, and associated with traditional CAD risk factors, and CAD mortality. BMI is also associated with autonomic dysregulation, adipose tissue derived proinflammatory cytokines, which are also attendant to emotion provoked myocardial ischemia. Thus, we sought to determine if body mass index (BMI) contributes to risk of developing myocardial ischemia provoked by mental stress. We performed a prospective interventional study in a cohort of 161 patients with stable CAD. They completed an assessment of myocardial blood flow with single photon emission computed tomography (SPECT) simultaneously during 2 conditions: laboratory mental stress and at rest. Multivariate logistic regression determined the independent contribution of BMI to the occurrence of mental-stress induced ischemia. Mean age was 65.6 ±9.0 years; 87.0% had a history of hypertension, and 28.6% had diabetes. Mean BMI was 30.4 ± 4.7. Prevalence of mental stress ischemia was 39.8%. BMI was an independent predictor of mental stress ischemia, OR=1.10, 95% CI [1.01-1.18] for one-point increase in BMI and OR=1.53, 95% CI [1.06-2.21] for a 4.7 point increase in BMI (one standard deviation beyond the cohort BMI mean), p=0.025 for all. These data suggest that BMI may serve as an independent risk marker for mental stress ischemia. The factors attendant with greater BMI, which include autonomic dysregulation and inflammation, may represent pathways by which high BMI contribute to this risk and serve as a conceptual construct to replicate these findings in larger CAD populations.
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Affiliation(s)
- Robert Soufer
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA.,VA Connecticut Healthcare System, West Haven Campus, West Haven, CT, USA
| | - Antonio B Fernandez
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Judith Meadows
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA.,VA Connecticut Healthcare System, West Haven Campus, West Haven, CT, USA
| | - Dorothea Collins
- VA Connecticut Healthcare System, West Haven Campus, West Haven, CT, USA
| | - Matthew M Burg
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA.,VA Connecticut Healthcare System, West Haven Campus, West Haven, CT, USA
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Zhao Y, Zhang X, Li J, Bian Y, Sheng M, Liu B, Fu Z, Zhang Y, Yang B. Jujuboside B Reduces Vascular Tension by Increasing Ca2+ Influx and Activating Endothelial Nitric Oxide Synthase. PLoS One 2016; 11:e0149386. [PMID: 26901291 PMCID: PMC4762982 DOI: 10.1371/journal.pone.0149386] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 02/01/2016] [Indexed: 11/24/2022] Open
Abstract
Jujuboside B has been reported to have protective effect on many cardiovascular diseases. However, the effects of Jujuboside B on vascular tension and endothelial function are unknown. The present study investigated the effects of Jujuboside B on reducing vascular tension, protecting endothelial function and the potential mechanisms. The tension of isolated rat thoracic aorta ring was measured by Wire myograph system. The concentration of nitric oxide (NO) and the activity of endothelial nitric oxide synthase (eNOS) in human aortic endothelial cells (HAECs) were determined by Griess reagent method and enzyme-linked immune sorbent assay. The protein levels of eNOS and p-eNOS at Serine-1177 were determined by western blot analysis. Intracellular Ca2+ concentration in HAECs was measured by laser confocal imaging microscopy. Results showed that Jujuboside B reduced the tension of rat thoracic aorta rings with intact endothelium in a dose-dependent manner. L-NAME, KN93, EGTA, SKF96365, iberiotoxin and glibenclamide significantly attenuated Jujuboside B-induced vasodilation in endothelium-intact tissues. In contrast, indometacin and 4-DAMP had no such effects. Jujuboside B also promoted NO generation and increased eNOS activity, which were attenuated by L-NAME, EGTA and SKF96365. Moreover, Jujuboside B increased intracellular Ca2+ concentration dose-dependently, which was inhibited by EGTA and SKF96365. Besides, Jujuboside B induced a rapid Ca2+ influx instantaneously after depleting intracellular Ca2+ store, which was significantly inhibited by SKF96365. In conclusion, this study preliminarily confirmed that Jujuboside B reduced vascular tension endothelium-dependently. The underlying mechanisms involved that Jujuboside B increased extracellular Ca2+ influx through endothelial transient receptor potential cation (TRPC) channels, phosphorylated eNOS and promoted NO generation in vascular endothelial cells. In addition, Jujuboside B-induced vasodilation involved endothelium-dependent hyperpolarizaiton through endothelial potassium channels. Jujuboside B is a natural compound with new pharmacological effects on improving endothelial dysfunction and treating vascular diseases.
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Affiliation(s)
- Yixiu Zhao
- Department of Pharmacology, Harbin Medical University, Harbin, Heilongjiang, PR China
- Key Laboratory of Cardiovascular Medicine Research (Harbin Medical University), Ministry of Education, Harbin, Heilongjiang, PR China
| | - Xin Zhang
- Department of Pharmacology, Harbin Medical University, Harbin, Heilongjiang, PR China
- Key Laboratory of Cardiovascular Medicine Research (Harbin Medical University), Ministry of Education, Harbin, Heilongjiang, PR China
| | - Jiannan Li
- Department of Pharmacology, Harbin Medical University, Harbin, Heilongjiang, PR China
- Key Laboratory of Cardiovascular Medicine Research (Harbin Medical University), Ministry of Education, Harbin, Heilongjiang, PR China
| | - Yu Bian
- Department of Pharmacology, Harbin Medical University, Harbin, Heilongjiang, PR China
- Key Laboratory of Cardiovascular Medicine Research (Harbin Medical University), Ministry of Education, Harbin, Heilongjiang, PR China
| | - Miaomiao Sheng
- Department of Pharmacology, Harbin Medical University, Harbin, Heilongjiang, PR China
- Key Laboratory of Cardiovascular Medicine Research (Harbin Medical University), Ministry of Education, Harbin, Heilongjiang, PR China
| | - Bin Liu
- Department of Pharmacology, Harbin Medical University, Harbin, Heilongjiang, PR China
- Key Laboratory of Cardiovascular Medicine Research (Harbin Medical University), Ministry of Education, Harbin, Heilongjiang, PR China
| | - Zidong Fu
- Department of Pharmacology, Harbin Medical University, Harbin, Heilongjiang, PR China
- Key Laboratory of Cardiovascular Medicine Research (Harbin Medical University), Ministry of Education, Harbin, Heilongjiang, PR China
| | - Yan Zhang
- Department of Pharmacology, Harbin Medical University, Harbin, Heilongjiang, PR China
- Key Laboratory of Cardiovascular Medicine Research (Harbin Medical University), Ministry of Education, Harbin, Heilongjiang, PR China
- * E-mail: (YZ); (BFY)
| | - Baofeng Yang
- Department of Pharmacology, Harbin Medical University, Harbin, Heilongjiang, PR China
- Key Laboratory of Cardiovascular Medicine Research (Harbin Medical University), Ministry of Education, Harbin, Heilongjiang, PR China
- * E-mail: (YZ); (BFY)
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49
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Affiliation(s)
- S S Arri
- Cardiovascular Division, British Heart Foundation Centre of Research Excellence, King's College London, The Rayne Institute, London, UK
| | - M Ryan
- Cardiovascular Division, British Heart Foundation Centre of Research Excellence, King's College London, The Rayne Institute, London, UK
| | - S R Redwood
- Cardiovascular Division, British Heart Foundation Centre of Research Excellence, King's College London, The Rayne Institute, London, UK
| | - M S Marber
- Cardiovascular Division, British Heart Foundation Centre of Research Excellence, King's College London, The Rayne Institute, London, UK
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Ohara K, Okita Y, Kouda K, Nakamura H. Comparison between Fast Fourier Transform and Autoregressive Model on Analysis of Autonomic Nervous Function after Food Intake in Women. Health (London) 2016. [DOI: 10.4236/health.2016.86060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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