Moazzami Kasra, Sullivan Samaah, Wang Maggie, Okoh Alexis K, Almuwaqqat Zakaria, Pearce Brad, Shah Amit J, Sun Yan V, Ko Yi-An, Raggi Paolo, Bremner J Douglas, Vaccarino Viola, Quyyumi Arshed A
Department of Medicine, Division of Cardiology Emory University School of Medicine Atlanta GA USA.
Department of Epidemiology, Rollins School of Public Health Emory University Atlanta GA USA.
J Am Heart Assoc. 2025 Feb 4;14(3):e034683. doi: 10.1161/JAHA.124.034683. Epub 2025 Jan 23.
Acute psychological stress may induce physiological changes predisposing individuals to adverse health outcomes through hemodynamic and vascular effects. We studied the association between the aggregated stress-induced changes in hemodynamic and vascular function tests with adverse cardiovascular outcomes in patients with coronary artery disease, after adjusting for sociodemographic and clinical factors.
Individuals with stable coronary artery disease from 2 prospective cohort studies were studied. Hemodynamic reactivity, changes in endothelial function, and vasoconstriction during mental stress were evaluated using changes in rate-pressure product, brachial artery flow-mediated vasodilation, and peripheral arterial tonometry, respectively. A cardiovascular reactivity risk score was calculated by allotting 0 to 3 points for each quartile of increasing abnormality for each of the 3 reactivity responses and summing the quartile points from the MIPS (Mental Stress Ischemia Prognosis Study) to yield a cardiovascular reactivity risk score ranging from 0 to 9. The outcome was a composite of cardiovascular death, nonfatal myocardial infarction, and heart failure hospitalizations during follow-up. A total of 629 participants were included. After adjustment for demographic and traditional risk factors, a blunted hemodynamic response, a greater decrease in flow-mediated vasodilation, and a greater degree of peripheral vasoconstriction to mental stress were all independently associated with a higher risk of adverse outcomes in both cohorts. By adding the cardiovascular reactivity risk score, the C-statistic increased significantly by 10% (<0.001).
Among individuals with stable coronary artery disease, a risk score derived from cardiovascular reactivity to mental stress was predictive of adverse cardiovascular outcomes beyond traditional cardiovascular risk factors.
急性心理应激可能通过血流动力学和血管效应诱发生理变化，使个体易出现不良健康后果。我们在调整社会人口统计学和临床因素后，研究了应激诱导的血流动力学和血管功能测试综合变化与冠心病患者不良心血管结局之间的关联。
对来自2项前瞻性队列研究的稳定型冠心病患者进行了研究。分别使用心率-血压乘积变化、肱动脉血流介导的血管舒张变化和外周动脉张力测定法评估心理应激期间的血流动力学反应性、内皮功能变化和血管收缩情况。通过为3种反应性反应中每一种异常程度增加的四分位数分配0至3分，并将心理应激缺血预后研究（MIPS）中的四分位数分数相加，得出心血管反应性风险评分，范围为0至9。结局为随访期间心血管死亡、非致死性心肌梗死和心力衰竭住院的综合情况。共纳入629名参与者。在调整人口统计学和传统危险因素后，血流动力学反应迟钝、血流介导血管舒张的更大程度降低以及心理应激时外周血管收缩程度更大，在两个队列中均与不良结局的较高风险独立相关。通过加入心血管反应性风险评分，C统计量显著增加了10%（<0.001）。
在稳定型冠心病患者中，源自心理应激心血管反应性的风险评分可预测超出传统心血管危险因素的不良心血管结局。
