精神应激性缺血预后研究：目标、研究设计及诱发性缺血的患病率
The Mental Stress Ischemia Prognosis Study: Objectives, Study Design, and Prevalence of Inducible Ischemia.
作者信息
Hammadah Muhammad, Al Mheid Ibhar, Wilmot Kobina, Ramadan Ronnie, Shah Amit J, Sun Yan, Pearce Brad, Garcia Ernest V, Kutner Michael, Bremner J Douglas, Esteves Fabio, Raggi Paolo, Sheps David S, Vaccarino Viola, Quyyumi Arshed A
机构信息
From the Division of Cardiology (Hammadah, Al Mheid, Wilmot, Ramadan, Shah, Vaccarino, Quyyumi), Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; Department of Epidemiology (Shah, Sun, Pearce, Raggi, Vaccarino), Rollins School of Public Health, Emory University, Atlanta, Georgia; Atlanta VA Medical Center (Shah, Bremner), Decatur, Georgia; Department of Radiology (Garcia, Esteves, Raggi), Emory University School of Medicine, Atlanta, Georgia; Department of Biostatistics and Bioinformatics (Kutner), Rollins School of Public Health, Emory University, Atlanta, Georgia; Department of Psychiatry and Behavioral Sciences (Bremner), Emory University School of Medicine; Mazankowski Alberta Heart Institute (Raggi), University of Alberta, Edmonton, Alberta, Canada; and Division of Cardiovascular Medicine (Sheps), Department of Medicine, University of Florida Health Science Center, Jacksonville, Florida.
出版信息
Psychosom Med. 2017 Apr;79(3):311-317. doi: 10.1097/PSY.0000000000000442.
OBJECTIVE
Mental stress-induced myocardial ischemia (MSIMI) is a common phenomenon in patients with coronary artery disease (CAD), but contemporary studies of its prognostic significance and its underlying pathophysiology are limited.
METHODS
We prospectively enrolled patients with confirmed CAD in the Mental Stress Ischemia Prognosis Study (MIPS) between 2011 and 2014. All patients underwent mental stress testing using a standardized public speaking task, and ischemia was detected by Tc-sestamibi myocardial perfusion imaging. Patients also underwent conventional stress testing for myocardial ischemia (CSIMI) using exercise or pharmacological stress testing. Furthermore, digital microvascular flow, endothelial function, arterial stiffness, and blood sample collections were performed before, during, and after mental stress. Two-year adverse clinical outcomes are being assessed.
RESULTS
Six-hundred ninety-five patients completed baseline enrollment in the MIPS. Their mean (standard deviation) age was 62.9 (9.1) years, 72% were men, 30% were African American, and 32% had a history myocardial infarction. The prevalence of MSIMI and CSIMI is 16.1% and 34.7%, respectively. A total of 151 patients (22.9%) had only CSIMI, 28 (4.2%) had only MSIMI, and 78 (11.8%) had both MSIMI and CSIMI. Patients with ischemia had a lower ejection fraction and higher prevalence of previous coronary artery bypass grafting compared with those without inducible ischemia (p < .050). The prevalence of obstructive CAD was not statistically different between patients with and without MSIMI (p = .426); in contrast, it was higher in patients with CSIMI (p < .001).
CONCLUSIONS
The MIPS data will provide useful information to assess the prognostic significance and underlying mechanisms of MSIMI.
目的
精神应激诱导的心肌缺血（MSIMI）在冠状动脉疾病（CAD）患者中是一种常见现象，但目前关于其预后意义及其潜在病理生理学的研究有限。
方法
我们在2011年至2014年期间对精神应激缺血预后研究（MIPS）中确诊为CAD的患者进行了前瞻性招募。所有患者均使用标准化的公开演讲任务进行精神应激测试，并通过锝- sestamibi心肌灌注成像检测缺血情况。患者还接受了使用运动或药物应激测试的传统心肌缺血应激测试（CSIMI）。此外，在精神应激前、应激期间和应激后进行了数字微血管血流、内皮功能、动脉僵硬度和血样采集。正在评估两年的不良临床结局。
结果
695名患者完成了MIPS的基线入组。他们的平均（标准差）年龄为62.9（9.1）岁，72%为男性，30%为非裔美国人，32%有心肌梗死病史。MSIMI和CSIMI的患病率分别为16.1%和34.7%。共有151名患者（22.9%）仅有CSIMI，28名（4.2%）仅有MSIMI，78名（11.8%）同时有MSIMI和CSIMI。与无诱发性缺血的患者相比，有缺血的患者射血分数较低，既往冠状动脉旁路移植术的患病率较高（p < 0.050）。有和无MSIMI的患者之间阻塞性CAD的患病率无统计学差异（p = 0.426）；相比之下，CSIMI患者的患病率更高（p < 0.001）。
结论
MIPS数据将为评估MSIMI的预后意义和潜在机制提供有用信息。
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