MENTAL STRESS-INDUCED ISCHEMIA IN THE LABORATORY AND AMBULATORY ISCHEMIA DURING DAILY-LIFE - ASSOCIATION AND HEMODYNAMIC FEATURES

Background The purpose of this study was to determine the corresponden ce of mental stress-induced ischemia in the laboratory with ambulatory ischemia and to assess the relationship between hemodynamic responses to mental stress and the occurrence of ischemia. Although exercise te sting is usually used to elicit myocardial ischemia, ischemia during d aily life usually occurs at relatively low heart rates and in the abse nce of strenuous physical exercise. Mental stress has been shown to tr igger ischemic events in the laboratory at lower heart rates but at bl ood pressures comparable to exercise. We therefore compared the extent to which mental stress and exercise testing identify patients who dev elop ischemia out of hospital. Methods and Results One hundred thirty- two patients with documented coronary disease and recent evidence of e xercise-induced myocardial ischemia underwent 48-hour ambulatory monit oring and radionuclide ventriculography during exercise and mental str ess testing. Patients who displayed mental stress-induced ischemia in the laboratory were more likely to exhibit ischemia during daily life (P<.021). Furthermore, patients who exhibited ischemia during ambulato ry monitoring displayed larger diastolic blood pressure (P<.006), hear t rate (P<.039), and rare-pressure product responses (P<.018) during m ental stress. Conclusions Among patients with prior positive exercise stress tests, mental stress-induced ischemia, defined by new wall moti on abnormalities, predicts daily ischemia independent of exercise-indu ced ischemia. Exaggerated hemodynamic responses during mental stress t esting also identify individuals who are more likely to exhibit myocar dial ischemia during daily life and mental stress.