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Mental stress-induced silent myocardial ischemia detected during ambulatory ventricular function monitoring

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Abstract

Background. Transient ischemic episodes at rest in patients with coronary artery disease have been attributed to mental stress. The means to monitor and record cardiac function changes due to mental stress is now available by utilizing the nuclear VEST. Methods and results. Eight, patients with angiographically documented coronary artery disease and 8 normal volunteers underwent a 4 hour session of continuous monitoring and recording of the left ventricular function, electrocardiogram, and blood pressure during exercise and mental stress. In the normal group, all subjects showed the expected normal response to exercise with an increase in ejection fraction, heart rate and blood pressure. During mental stress two subjects (25%) showed transient episodes of ejection fraction decrease that were not associated with chest pain, ST changes or significant changes in blood pressure. In the group of coronary artery disease patients, five (63%) had an ischemic response to exercise by electrocardiographic and radionuclide ventriculography criteria with evidence of chest pain in three of them. All of them revealed transient episodes of left ventricular dysfunction during mental stress. Episodes were painless, occurred at low heart rate and in most cases were accompanied by ST-segment changes. The rest of the patients with a normal response to exercise showed slight changes of the ejection fraction above the baseline. Conclusion. The results provide evidence that there is marked disparity in the incidence of chest pain and ST-segment changes, despite similar ischemic ejection fraction response between mental and physical stress. This is indicative of a major role of mental stress in provoking silent ischemia that potentially might provide additional clinical information compared to exercise test.

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References

  1. Rozanski A, Berman DS. Silent myocardial ischemia. Pathophysiology, frequency of occurrence, and approaches toward detection. Am Heart J 1987; 114: 615-26.

    Google Scholar 

  2. Vassiliadis I, Machac J, Sharma S et al. Detection of silent left ventricular dysfunction during routine daily activities in coronary artery disease patients by the nuclear VEST. J Am Coll Cardiol 1990; 15: 148 (abstr).

    Google Scholar 

  3. Rozanski A, Bairey I, Krantz DS et al. Mental stress and the induction of silent myocardial ischemia in patients with coronary artery disease. N Engl J Med 1988; 318: 1005-12.

    Google Scholar 

  4. Tamaki N, Gill TB, Moore RH, Yasuda T, Boucher CA, Strauss CW. Cardiac responses to daily activities and exercise in normal subjects assessed by an ambulatory ventricular function monitor. Am J Cardiol 1987; 59: 1164-9.

    Google Scholar 

  5. Vassiliadis I, Machac J, Sharma S, Horowitz SF, Goldsmith SJ. Detection of silent left ventricular dysfunction during routine daily activities in coronary artery disease patients by the Nuclear VEST. Journal of Nuclear Biology and Medicine 1993; 37: 198-206.

    Google Scholar 

  6. Kayden DS, Remetz MS, Cabin HS et al. Validation of continuous radionuclide left ventricular function monitoring in detecting silent myocardial ischemia during baloon angioplasty of the left anterior descending artery. Am J Cardiol 1991; 67: 1339-43.

    Google Scholar 

  7. Deanfield JE, Kensett M, Wilson RA, et al. Silent myocardial ischemia due to mental stress. Lancet 1984; 2: 1001-5.

    Google Scholar 

  8. Giubbini R, Calli M, Campini R, Bosiminn E, Bencivelli W, Tavazzi L. Effects of mental stress on myocardial perfusion imaging in patients with ischemic heart disease. Circulation 1991; 83 (Supp II): II-100-7.

    Google Scholar 

  9. Zaret BL, Kayden DS. Ambulatory monitoring of left ventricular function: a new modality for assessing silent myocardial ischemia. Vol. 37. In: Kellerman JJ, Braunwald E, (eds). Silent myocardial ischemia: a critical appraisal. Advances in cardiology. Basel: Karger 1990: 105-16.

    Google Scholar 

  10. Callahan RJ, Froelich JW, Mc Kusick KA, Leppo J, Strauss HW. A modified method for the in-vivo labeling of red blood cells with Tc-99m. J Nuc Med 1982; 23: 315-8.

    Google Scholar 

  11. Wilson RA, Sulliran PJ, Moore RH. An ambulatory ventricular function monitor: validation and preliminary results. Am J Cardiol 1983 52: 601-6.

    Google Scholar 

  12. McKinney OD, Miner OE, Ruddel et al. The standardized mental stress test protocol: test-retest reliability and comparison with ambulatory blood pressure monitoring. Psychophysiology 1988; 25: 645-56.

    Google Scholar 

  13. Steptoe A, Vogele C. Methodology of Mental stress testing in cardiovascular research. Circulation 1991; 83 (supp II) II-24.

    Google Scholar 

  14. Tamaki N, Yasuda T, Moore RH et al. Continuous monitoring of left ventricular function by an ambulatory radionuclide detector in patients with coronary artery disease. J Am Coll Cardiol 1988; 12 669-79

    Google Scholar 

  15. Breisblatt W, Weiland FL, Mclaim JR et al. Usefulness of ambulatory radionuclide monitoring of the left ventricular function early after acute myocardial infarction predicting residual myocardial ischemia. Am J Cardiol 1988; 62: 1005.

    Google Scholar 

  16. Spechia G, De Servis S, Falcone C et al. Mental arithmetic stress testing in patients with coronary disease. Am Heart J 1984; 108: 56-63.

    Google Scholar 

  17. Waters D, Luz P, Wyatt H, Swann H, Forrester J. Early changes in regional and global left ventricular function induced by graded reductions in regional coronary perfusion. Am J Cardiol 1987; 39: 537-43.

    Google Scholar 

  18. Crawford MH, Mendoza CA, O'Rourke R et al. Limitations of continuous ambulatory electrocardiographic monitoring for detecting coronary artery disease. Ann Intern Med 1983; 98: 249-51.

    Google Scholar 

  19. Kayden DE, Wackers FJ, Zaret BL. Silent left ventricular dysfunction during routine activity after thrombolytic therapy for acute myocardial infarction. J Am Coll Cardiol 1990; 15: 1500-7.

    Google Scholar 

  20. Yeung AG, Venkstein VI, Krantz DS et al. The effect of atherosclerosis on the vasomotor response of coronary arteries to mental stress. N Engl J Med 1991; 325: 1551-6.

    Google Scholar 

  21. Bairey CN, Yang L, Bermann SD, Rozanski A et al. Comparison of physiologic ejection fraction response to activities of daily living. Implications for clinical testing. J Am Coll Cardiol 1990; 16: 847-54.

    Google Scholar 

  22. Rozanski A, Krantz DS, Bairey CN. Ventricular responses to mental stress testing in patients with coronary artery disease. Circulation 1991; 83(suppl II): II137-II144.

    Google Scholar 

  23. Carpegghiani C, Skinner JE. Coronary flow and metal stress Circulation 1991; 83 (suppl II) II-193.

    Google Scholar 

  24. Kiess MC, Dimsdale JE, Moore RH et al. The effects of stress on left ventricular ejection fraction. Eur J Nucl Med 1988; 18: 12-630.

    Google Scholar 

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Authors and Affiliations

  1. Departments of Cardiology and Nuclear Medicine, Athens Naval Hospital, Athens, Greece

    Ioannis V. Vassiliadis, Alexandros I. Fountos, Athanassios G. Papadimitriou & Evagelos C. Sbonias

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  1. Ioannis V. Vassiliadis
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  2. Alexandros I. Fountos
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  3. Athanassios G. Papadimitriou
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  4. Evagelos C. Sbonias
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Vassiliadis, I.V., Fountos, A.I., Papadimitriou, A.G. et al. Mental stress-induced silent myocardial ischemia detected during ambulatory ventricular function monitoring. Int J Cardiovasc Imaging 14, 171–177 (1998). https://doi.org/10.1023/A:1005911922139

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