Hemodynamic, catecholamine, vasomotor and vascular responses: Determinants of myocardial ischemia during mental stress

Aims: Mental stress-induced myocardial ischemia (MSIMI) in patients with coronary artery disease (CAD) is associatedwith adverse cardiovascular outcomes. Weaimto assess hemodynamic, neuro-hormonal, endothelial, vasomotor and vascular predictors of MSIMI. Methods and results: We subjected 660 patients with stable CAD to 99mTc sestamibimyocardial perfusion imaging at rest, with mental (speech task) and with conventional (exercise/pharmacological) stress. Endotheliumdependent flow-mediated dilation (FMD), microvascular reactivity [reactive hyperemia index (RHI)] and arterial stiffness [pulse wave velocity (PWV)] were measured at rest and 30-min after mental stress. The digital microvascular vasomotor response during mental stress was assessed using peripheral arterial tonometry (PAT). A total of 106(16.1%) patients had MSIMI. Mental stress was accompanied by significant increases in ratepressure-product (heart rate x systolic blood pressure; RPP), epinephrine levels and PWV, and significant decreases in FMD and PAT ratio denotingmicrovascular constriction. In comparison to those with noMSIMI, patients with MSIMI had higher hemodynamic and digital vasoconstrictive responses (p < 0.05 for both), but did not differ in epinephrine, endothelial ormacrovascular responses. Only presence of ischemia during conventional stress (OR of 7.1, 95% CI of 4.2, 11.9), high hemodynamic response (OR for RPP response >= vs < ROC cutoff of 1.8, 95% CI of 1.1, 2.8), and high digital vasoconstriction (OR for PAT ratio < vs >= ROC cutoff of 2.1, 95% CI of 1.3, 3.3) were independent predictors of MSIMI. Conclusion: Ischemia during conventional stress testing and hemodynamic and vasoconstrictive responses to mental stress can help predict subjects with CAD at greater risk of developing MSIMI. (C) 2017 Elsevier B. V. All rights reserved.