TY - JOUR
T1 - Mental stress peripheral vascular reactivity is elevated in women with coronary vascular dysfunction
T2 - Results from the NHLBI-sponsored Cardiac Autonomic Nervous System (CANS) study
AU - Mehta, Puja K.
AU - Hermel, Melody
AU - Nelson, Michael D.
AU - Cook-Wiens, Galen
AU - Martin, Elizabeth A.
AU - Alkhoder, Ayman A.
AU - Wei, Janet
AU - Minissian, Margo
AU - Shufelt, Chrisandra L.
AU - Marpuri, Sailaja
AU - Hermel, David
AU - Shah, Amit
AU - Irwin, Michael R.
AU - Krantz, David S.
AU - Lerman, Amir
AU - Noel Bairey Merz, C.
N1 - Publisher Copyright:
© 2017 Elsevier B.V.
PY - 2018/1/15
Y1 - 2018/1/15
N2 - 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 ± 10 years (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.
AB - 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 ± 10 years (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.
KW - Mental stress
KW - Microvascular dysfunction
KW - Vascular reactivity
KW - Women heart disease
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U2 - 10.1016/j.ijcard.2017.10.061
DO - 10.1016/j.ijcard.2017.10.061
M3 - Article
C2 - 29103858
AN - SCOPUS:85032986394
SN - 0167-5273
VL - 251
SP - 8
EP - 13
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -