Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
Chin Med J (Engl). 2019 Jun 20;132(12):1390-1399. doi: 10.1097/CM9.0000000000000260.
Mental stress-induced myocardial ischemia (MSIMI) is closely associated with adverse cardiac events in patients with coronary artery disease (CAD) and we aimed to determine whether biomarkers and blood pressure could be potential predictors of MSIMI.
This study enrolled 82 patients with documented CAD between June 1, 2017 and November 9, 2017. Patient blood samples were obtained at resting period and at the end of mental arithmetic. Then, patients were assigned to MSIMI positive group and MSIMI negative group. The main statistical methods included linear regression, receiver operating characteristic (ROC) curves, and logistic regression.
Patients with CAD with MSIMI had significantly greater median resting N-terminal pro-brain natriuretic peptide (NT-proBNP, 141.02 [45.85-202.76] pg/mL vs. 57.95 [27.06-117.64] pg/mL; Z = -2.23, P = 0.03) and mean systolic blood pressure (SBP) (145.56 ± 16.87 mmHg vs. 134.92 ± 18.16 mmHg, Z = -2.13, P = 0.04) when compared with those without MSIMI. After 5-min mental stress task, those who developed MSIMI presented higher elevation of median post-stressor high sensitivity cardiac troponin I (hs-cTnI, 0.020 [0.009-0.100] ng/mL vs. 0.009 [0.009-0.010] ng/mL; Z = -2.45, P = 0.01), post-stressor NT-proBNP (138.96 [39.93-201.56] pg/mL vs. 61.55 [25.66-86.50] pg/mL; Z = -2.15, P = 0.03) compared with those without MSIMI. Using the ROC curves, and after the adjustment for basic characteristics, the multiple logistic regression analysis showed that patients presenting a post-stressor hs-cTnI ≥ 0.015 ng/mL had seven-fold increase in the risk of developing MSIMI (odds ratio [OR]: 7.09; 95% confidence interval [CI]: 1.65-30.48; P = 0.009), a rest NT-proBNP ≥ 80.51 pg/mL had nearly eight-fold increase (OR: 7.85; 95% CI: 1.51-40.82; P = 0.014), a post-stressor NT-proBNP ≥ 98.80 pg/mL had 35-fold increase (OR: 34.96; 95% CI: 3.72-328.50; P = 0.002), a rest SBP ≥ 129.50 mmHg had 11-fold increase (OR: 11.42; 95% CI: 1.21-108.17; P = 0.034).
The present study shows that CAD patients with higher hs-cTnI level, and/or greater NT-proBNP and/or SBP are at higher risk of suffering from MSIMI when compared with those without MSIMI, indicating that hs-cTnI, NT-proBNP, SBP might be potential predictors of MSIMI.
精神应激诱发的心肌缺血（MSIMI）与冠心病（CAD）患者的不良心脏事件密切相关，本研究旨在确定生物标志物和血压是否是 MSIMI 的潜在预测因素。
本研究纳入了 2017 年 6 月 1 日至 2017 年 11 月 9 日期间确诊 CAD 的 82 例患者。患者在休息期和心算结束时采集血液样本。然后，将患者分为 MSIMI 阳性组和 MSIMI 阴性组。主要的统计方法包括线性回归、受试者工作特征（ROC）曲线和逻辑回归。
患有 CAD 并出现 MSIMI 的患者，静息状态下的中位 N 末端脑钠肽前体（NT-proBNP）明显更高（141.02 [45.85-202.76] pg/ml 比 57.95 [27.06-117.64] pg/ml；Z=-2.23，P=0.03），收缩压（SBP）均值也更高（145.56±16.87 mmHg 比 134.92±18.16 mmHg，Z=-2.13，P=0.04）。与无 MSIMI 的患者相比，在进行 5 分钟的精神压力任务后，出现 MSIMI 的患者中位应激后高敏心肌肌钙蛋白 I（hs-cTnI）升高更明显（0.020 [0.009-0.100] ng/ml 比 0.009 [0.009-0.010] ng/ml；Z=-2.45，P=0.01），应激后 NT-proBNP 也更高（138.96 [39.93-201.56] pg/ml 比 61.55 [25.66-86.50] pg/ml；Z=-2.15，P=0.03）。使用 ROC 曲线，并在调整基本特征后，多因素逻辑回归分析显示，应激后 hs-cTnI≥0.015 ng/ml 的患者发生 MSIMI 的风险增加 7 倍（比值比[OR]：7.09；95%置信区间[CI]：1.65-30.48；P=0.009），静息 NT-proBNP≥80.51 pg/ml 的患者发生 MSIMI 的风险增加近 8 倍（OR：7.85；95% CI：1.51-40.82；P=0.014），应激后 NT-proBNP≥98.80 pg/ml 的患者发生 MSIMI 的风险增加 35 倍（OR：34.96；95% CI：3.72-328.50；P=0.002），静息 SBP≥129.50 mmHg 的患者发生 MSIMI 的风险增加 11 倍（OR：11.42；95% CI：1.21-108.17；P=0.034）。
本研究表明，与无 MSIMI 的患者相比，hs-cTnI 水平较高、NT-proBNP 和/或 SBP 较高的 CAD 患者发生 MSIMI 的风险更高，提示 hs-cTnI、NT-proBNP、SBP 可能是 MSIMI 的潜在预测因素。
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