Gottdiener J S, Krantz D S, Howell R H, Hecht G M, Klein J, Falconer J J, Rozanski A
Department of Medicine, Georgetown University Hospital, Washington, D.C. 20007.
J Am Coll Cardiol. 1994 Dec;24(7):1645-51. doi: 10.1016/0735-1097(94)90169-4.
This study examined the relations among the triggers of ischemia during the activities of daily life, mental stress-induced ischemia in the laboratory and functional severity of ischemia on exercise testing.
Myocardial ischemia is readily induced with exercise testing, but most episodes of ischemia in daily life occur during relatively sedentary activities. Although mental and emotional arousal are known to trigger myocardial ischemia, mental stress testing induces ischemia in only approximately 50% of patients with active coronary disease. It is not known whether such patients are particularly susceptible to nonexertional ischemia during daily activity.
We studied 45 men (mean age +/- SD 58 +/- 9 years) with coronary artery disease by means of 48-h Holter ambulatory electrocardiography for ST segment analysis and quantification of physical and mental activity with a structured diary system. These data were cross-tabulated with new left ventricular dyssynchrony (detected on two-dimensional echocardiography) induced by two mental stressors and by bicycle exercise.
During mental stress testing, 24 patients (53%) (Group I) had a new wall motion abnormality; the other 21 patients (Group II) did not. The average wall motion dyssynchrony score increased from 1.20 +/- 0.29 to 1.34 +/- 0.36 (p = 0.001), but the increase was less than that with exercise stress (1.52 +/- 0.41, p = 0.001). The total duration of ischemia during sedentary activities was greater in Group I (22.9 +/- 24.5 min) than in Group II (3.6 +/- 3.9 min, p = 0.025). Group I had more ischemic events while sedentary (23 of 290 diary entries) than did Group II (8 of 256 diary entries, p = 0.015). The magnitude of dyssynchrony with mental stress and the number of mental stressors capable of triggering ischemia were related to severity of ischemia with exercise.
Patients with ischemia during mental stress testing also have increased ischemia during sedentary activities in daily life. This finding may reflect greater functional severity of coronary artery disease or a propensity toward coronary vasoconstriction while sedentary.
本研究探讨日常生活活动期间的缺血触发因素、实验室中心理应激诱发的缺血与运动试验中缺血功能严重程度之间的关系。
运动试验很容易诱发心肌缺血，但日常生活中的大多数缺血发作发生在相对久坐的活动期间。虽然已知精神和情绪激动会触发心肌缺血，但心理应激试验仅在约50%的活动性冠心病患者中诱发缺血。尚不清楚此类患者在日常活动期间是否特别易患非运动性缺血。
我们通过48小时动态心电图监测ST段，并用结构化日记系统对45名患有冠状动脉疾病的男性（平均年龄±标准差58±9岁）的身体和精神活动进行量化研究。这些数据与由两种心理应激源和自行车运动诱发的新的左心室不同步（通过二维超声心动图检测）进行交叉制表分析。
在心理应激试验期间，24名患者（53%）（第一组）出现新的室壁运动异常；其他21名患者（第二组）未出现。平均室壁运动不同步评分从1.20±0.29增加到1.34±0.36（p = 0.001），但增加幅度小于运动应激时（1.52±0.41，p = 0.001）。第一组久坐活动期间的缺血总时长（22.9±24.5分钟）长于第二组（3.6±3.9分钟，p = 0.025）。第一组久坐时的缺血事件（290条日记记录中有23次）多于第二组（256条日记记录中有8次，p = 0.015）。心理应激时的不同步程度以及能够触发缺血的心理应激源数量与运动时缺血的严重程度相关。
心理应激试验期间出现缺血的患者在日常生活久坐活动期间的缺血也会增加。这一发现可能反映了冠状动脉疾病功能严重程度更高，或久坐时冠状动脉血管收缩倾向更大。
