Se. Legault et al., USEFULNESS OF ISCHEMIC RESPONSE TO MENTAL STRESS IN PREDICTING SILENT-MYOCARDIAL-ISCHEMIA DURING AMBULATORY MONITORING, The American journal of cardiology, 75(15), 1995, pp. 1007-1011
To evaluate the relation of mental stress-induced ischemia to silent i
schemia on ambulatory monitoring, 46 patients with stable coronary art
ery disease underwent standardized laboratory mental stress and exerci
se treadmill testing according to National institutes of Health protoc
ol during which left ventricular election fraction (EF) was determined
using the nuclear VEST. Life stress, type A behavior, and hostility w
ere determined using standard interviews, Subsequently, 48-hour ambula
tory electrocardiographic monitoring was performed. Twenty-three patie
nts (50%) had an ischemic response (left ventricular EF decrease great
er than or equal to 5%) to mental stress, which was associated with am
bulatory ischemia (13 of 19 with ambulatory ischemia had mental stress
-induced ischemia vs 10 of 27 without ambulatory ischemia, p = 0.04).
Left ventricular EF response to mental stress was a significant predic
tor of ambulatory ischemia independent of EF response to exercise (F =
4.8, p = 0.03), patients with mental stress-induced ischemia had long
er total duration (31.4 +/- 57.0 vs 8.3 +/- 18 minutes, p = 0.06) and
more frequent episodes of ambulatory ischemia (3.1 +/- 4.6 vs 0.9 +/-
1.9 episodes, p = 0.03), Life stress, type A behavior, and hostility w
ere not associated with prevalence or severity of ambulatory ischemia,
In conclusion, an ischemic response to mental stress is significantly
associated with higher prevalence, longer duration, and more frequent
episodes of ambulatory ischemia.