Becker L C, Pepine C J, Bonsall R, Cohen J D, Goldberg A D, Coghlan C, Stone P H, Forman S, Knatterud G, Sheps D S, Kaufmann P G
Division of Cardiology, Johns Hopkins Medical Institutions, Baltimore, Md, USA.
Circulation. 1996 Dec 1;94(11):2768-77. doi: 10.1161/01.cir.94.11.2768.
The normal cardiovascular response to mental stress in middle-aged and older people has not been well characterized.
We studied 29 individuals 45 to 73 years old (15 women, 14 men) who had no coronary risk factors, no history of coronary artery disease, and a negative exercise test. Left ventricular (LV) volumes and global and regional function were assessed by radionuclide ventriculography at rest and during two 5-minute standardized mental stress tasks (simulated public speaking and the Stroop Color-Word Test), administered in random order. A substantial sympathetic response occurred with both mental stress tests, characterized by increases in blood pressure, heart rate, rate-pressure product, cardiac index, and stroke work index and rises in plasma levels of epinephrine and norepinephrine but not beta-endorphin or cortisol. Despite this sympathetic response, LV volume increased and ejection fraction (EF) decreased secondary to an increase in afterload. The change in EF during mental stress-varied among individuals but was associated positively with changes in LV contractility and negatively with baseline EF and changes in afterload. EF decreased > 5% during mental stress in 12 individuals and > 8% in 5; 3 developed regional wall motion abnormalities.
Mental stress in the laboratory results in a substantial sympathetic response in normal middle-aged and older men and women, but EF commonly falls because of a concomitant rise in afterload. These results provide essential age- and sex-matched reference data for studies of mental stress-induced ischemia in patients with coronary artery disease.
中老年人对精神压力的正常心血管反应尚未得到充分描述。
我们研究了29名年龄在45至73岁之间的个体（15名女性，14名男性），他们没有冠心病危险因素，没有冠状动脉疾病史，运动试验结果为阴性。通过放射性核素心室造影在静息状态以及两项5分钟标准化精神压力任务（模拟公开演讲和斯特鲁普色词测验）期间评估左心室（LV）容积以及整体和局部功能，两项任务按随机顺序进行。两项精神压力测试均引发了显著的交感神经反应，其特征为血压、心率、心率-血压乘积、心脏指数和每搏功指数升高，血浆肾上腺素和去甲肾上腺素水平升高，但β-内啡肽或皮质醇水平未升高。尽管有这种交感神经反应，但由于后负荷增加，LV容积增加，射血分数（EF）下降。精神压力期间EF的变化在个体间存在差异，但与LV收缩性的变化呈正相关，与基线EF和后负荷的变化呈负相关。12名个体在精神压力期间EF下降>5%，5名个体下降>8%；3名个体出现局部室壁运动异常。
实验室中的精神压力会在正常中老年男性和女性中引发显著的交感神经反应，但EF通常会因后负荷同时增加而下降。这些结果为研究冠状动脉疾病患者精神压力诱导的缺血提供了重要的年龄和性别匹配的参考数据。
