Department of Epidemiology (J.O., V.V., A.S.S., L.Y.L., B.D.P., P.R., Y.V.S., L.C., A.J.S.), Rollins School of Public Health, Emory University, Atlanta, GA.
Department of Medicine, Division of Cardiology, Emory Clinical Cardiovascular Research Institute (V.V., M.W., A.A.Q., H.A., G.H., O.D., T.R., L.S., A.J.S.), Emory University School of Medicine, Atlanta, GA.
Circ Cardiovasc Imaging. 2024 Jun;17(6):e016596. doi: 10.1161/CIRCIMAGING.124.016596. Epub 2024 Jun 13.
Mental stress-induced myocardial ischemia (MSIMI) is associated with adverse cardiovascular outcomes in individuals with coronary artery disease, but the mechanisms underlying this phenomenon are unknown. We examined the relationship between stress-induced autonomic dysfunction, measured by low heart rate variability (HRV) in response to stress, and MSIMI in patients with stable coronary artery disease. We hypothesized that stress-induced autonomic dysfunction is associated with higher odds of MSIMI.
In 735 participants with stable coronary artery disease, we measured high- and low-frequency HRV in 5-minute intervals before and during a standardized laboratory-based speech stressor using Holter monitoring. HRV at rest and stress were categorized into low HRV (first quartile) versus high HRV (second to fourth quartiles); the low category was used as an indicator of autonomic dysfunction. Multivariable logistic regression models were used to examine the association of autonomic dysfunction with MSIMI.
The mean age was 58 (SD, ±10) years, 35% were women, 44% were Black participants, and 16% developed MSIMI. Compared with high HRV during stress, low HRV during stress (both high and low frequencies) was associated with higher odds of MSIMI after adjusting for demographic and clinical factors (odds ratio for high-frequency HRV, 2.1 [95% CI, 1.3-3.3]; odds ratio for low-frequency HRV, 2.1 [95% CI, 1.3-3.3]). Low-frequency HRV at rest was also associated with MSIMI but with slightly reduced effect estimates.
In individuals with coronary artery disease, mental stress-induced autonomic dysfunction may be a mechanism implicated in the causal pathway of MSIMI.
精神应激引起的心肌缺血（MSIMI）与冠心病患者不良心血管结局相关，但该现象的发生机制尚不清楚。我们研究了应激引起的自主神经功能障碍与稳定型冠心病患者 MSIMI 之间的关系。我们假设应激引起的自主神经功能障碍与 MSIMI 的发生几率升高有关。
在 735 名稳定型冠心病患者中，我们使用动态心电图监测，在 5 分钟间隔内测量基线和标准化实验室言语应激期间的高频和低频心率变异性（HRV）。HRV 在静息和应激时分为低 HRV（第一四分位数）和高 HRV（第二至第四四分位数）；低类别作为自主神经功能障碍的指标。多变量逻辑回归模型用于研究自主神经功能障碍与 MSIMI 的关系。
平均年龄为 58（±10）岁，35%为女性，44%为黑人，16%发生 MSIMI。与应激时高 HRV 相比，应激时低 HRV（高频和低频）在调整人口统计学和临床因素后与 MSIMI 的发生几率升高相关（高频 HRV 的优势比为 2.1 [95%CI，1.3-3.3]；低频 HRV 的优势比为 2.1 [95%CI，1.3-3.3]）。静息时低频 HRV 也与 MSIMI 相关，但效应估计值略有降低。
在冠心病患者中，精神应激引起的自主神经功能障碍可能是 MSIMI 因果途径中的一个机制。
