[Physician Comment] Mental stress-induced myocardial ischemia more common than exercise-induced

Feb 14th – In patients with stable coronary artery disease, mental stress induced myocardial ischemia in more patients than conventional exercise stress test. 

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Image: CC. Disability-adjusted life year for ischaemic heart disease per 100,000 inhabitants in 2004.

1. In patients with stable coronary artery disease, mental stress induced myocardial ischemia in more patients than conventional exercise stress test.

2. Mental stress induced myocardial ischemia was more likely in women and unmarried subjects when compared with married males.

Mental stress is a significant contributor to ischemia in myocardial tissue, and ischemia is the best known surrogate marker for risk of future cardiovascular events. Screening patients with exercise stress tests alone missed 21.6% of patients who showed evidence of ischemia by mental stress provocation. The same mental stress stimulus was more likely to induce myocardial ischemia in subjects that were female, unmarried, or living alone. With this data in mind, the REMIT trial is investigating the efficacy of SSRIs on mental stress induced myocardial ischemia.

Click to read the study in The Journal of the American College of Cardiology

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Image: CC. Disability-adjusted life year for ischaemic heart disease per 100,000 inhabitants in 2004.

1. In patients with stable coronary artery disease, mental stress induced myocardial ischemia in more patients than conventional exercise stress test.

2. Mental stress induced myocardial ischemia was more likely in women and unmarried subjects when compared with married males.

Study author, Dr. Wei Jiang, MD, talks to 2 Minute Medicine: Principle Investigator Duke University Medical Center

“I’d be very cautious about the “married women” are at higher risk than unmarried women for mental stress induced myocardial ischemia (MSIMI), because the sample size was quite small for this analysis. I think it is safe to state the married men seem to be protected from having MSIMI. The role of marriage in women in terms of MSIMI need to be further investigated.”

This [prospective] study: evaluated ventricular response in 310 patients after mental and exercise stress tests. Mental stress induced myocardial ischemia was significantly more frequent than exercise induced myocardial ischemia (43.5% vs 33.8%, p=0.003). Relative to married men, unmarried men and married women were significantly more likely to show mental stress induced myocardial ischemia (OR of 2.57 and 3.18 respectively). Interestingly, while female and unmarried subjects overall had a higher risk of mental stress induced myocardial ischemia, female unmarried subjects tended towards a lower risk than female married subjects.

In sum: Mental stress is a significant contributor to ischemia in myocardial tissue, and ischemia is the best known surrogate marker for risk of future cardiovascular events. Screening patients with exercise stress tests alone missed 21.6% of patients who showed evidence of ischemia by mental stress provocation. The same mental stress stimulus was more likely to induce myocardial ischemia in subjects that were female, unmarried, or living alone. With this data in mind, the REMIT trial is investigating the efficacy of SSRIs on mental stress induced myocardial ischemia.

Click to read the study in The Journal of the American College of Cardiology

By Gina  Siddiqui and Allen Ho

More from this author: [Physician Comment] Hybrid operating rooms shed light on coronary status in aortic dissections, Ischemia-reperfusion injury central in early mortality after thoracic endovascular aortic repair (TEVAR), An argument against hospital admission for heart failure

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