From the Department of Epidemiology (Pimple, Sullivan, Shah, Lewis, Vaccarino), Rollins School of Public Health, Emory University; Department of Medicine (Hammadah, Wilmot, Ramadan, Al Mheid, Levantsevych, Lima, Kim, Shah, Quyyumi, Vaccarino), Division of Cardiology, Emory University; Department of Radiology & Imaging Science (Garcia, Nye), Emory University School of Medicine; Department of Biostatistics & Bioinformatics (Ward, Hanfelt), Rollins School of Public Health, Emory University, Atlanta, Georgia; Mazankowski Alberta Heart Institute (Raggi), University of Alberta, Edmonton, Alberta, Canada; and Department of Psychiatry and Behavioral Sciences (Bremner), Emory University School of Medicine, Atlanta, Georgia.
Psychosom Med. 2019 May;81(4):363-371. doi: 10.1097/PSY.0000000000000674.
Mental stress-induced myocardial ischemia is a frequent phenomenon in patients with coronary artery disease (CAD). The link between an integrated measure of chronic psychosocial distress and mental stress-induced myocardial ischemia, and whether it differs by sex, has not been examined before.
We used latent class analysis to derive a composite measure of psychosocial distress integrating scales of depression, posttraumatic stress, anxiety, anger, hostility, and perceived stress in 665 individuals with stable CAD. Participants underwent myocardial perfusion imaging with mental stress and perfusion defects were quantified at rest (summed rest score), with mental stress (summed stress score), and their difference (summed difference score), the latter being an index of inducible ischemia.
The M (SD) age was 63 (9) years, and 185 (28%) were women. Latent class analysis characterized the study sample into four distinct classes of incremental psychosocial distress. In women, class 4 (highest distress) had an adjusted 4.0-point higher summed rest score (95% confidence interval = 0.2-7.7) as compared with class 1 (lowest distress), whereas no difference was observed in men (-0.87 points, 95% confidence interval = -3.74 to 1.99, p = .04 for interaction). There was no association between the psychosocial distress latent variable and summed difference score in either women or men.
Among patients with CAD, a higher level of psychosocial distress is not associated with mental stress ischemia, but it is associated with more resting (fixed) perfusion abnormalities in women only, as well as with blunted hemodynamic response to mental stress in both men and women.
精神应激引起的心肌缺血是冠心病（CAD）患者的常见现象。慢性心理社会压力的综合指标与精神应激引起的心肌缺血之间的联系，以及这种联系是否因性别而异，以前尚未研究过。
我们使用潜在类别分析从 665 名稳定型 CAD 患者的抑郁、创伤后应激、焦虑、愤怒、敌意和感知压力量表中得出一个综合的心理社会压力指标。参与者接受了精神应激下的心肌灌注成像，并在静息时（总和静息评分）、精神应激时（总和应激评分）和两者之间的差异（总和差值评分）量化了灌注缺陷，后者是诱导性缺血的指标。
M（SD）年龄为 63（9）岁，185 人（28%）为女性。潜在类别分析将研究样本分为四个不同类别的递增心理社会压力。在女性中，第 4 类（压力最大）的总和静息评分比第 1 类（压力最小）高 4.0 分（95%置信区间为 0.2-7.7），而男性则无差异（-0.87 分，95%置信区间为-3.74 至 1.99，交互作用 p 值为.04）。在女性或男性中，心理社会压力潜在变量与总和差值评分均无关联。
在 CAD 患者中，更高水平的心理社会压力与精神应激性缺血无关，但仅与女性的静息（固定）灌注异常增加有关，以及与男性和女性的精神应激时血流动力学反应减弱有关。
