Mental stress increases right heart afterload in severe pulmonary hypertension

Little is known about mental stress effects on the pulmonary circulation in health and disease. The current study was conducted to investigate whether pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR) wo uld further increase during standardized mental stress testing in patients with severe pulmonary hypertension. The study was a prospective analysis of seven patients (average age: 40 years, range from 21 to 56 years) with sev ere pulmonary hypertension (primary: n = 4, secondary forms: n = 3; resting mean pulmonary artery pressure ranged between 48 and 65 mmHg). Right heart catheterization for the determination of PAP, pulmonary capillary wedge pr essure (PCW) and cardiac output (CO) was clinically indicated (diagnostic w ork-up, acute drug testing). Patients accomplished a standardized 10 min me ntal stress test (computer based, adaptive complex reaction-time task). Pul monary haemodynamics during stress were compared to resting baseline. Durin g mental stress mean PAP (+/- SEM) increased by 9.4 +/- 2.1 mmHg (P < 0.005 ). Pulmonary vascular resistance increased by 149 +/- 25 dyne s cm(-5) (P < 0.001). Stroke volume decreased by 6.6 +/- 2.2 ml (P < 0.03). The data sho w that moderate mental stress increases right heart afterload in patients w ith severe pulmonary hypertension owing to elevation of PVR.