Article

Aims Mental stress-induced myocardial ischemia (MSIMI) occurs in up to 70% of
patients with clinically stable ischemic heart disease and is associated with
increased risk of adverse prognosis. We aimed to examine the prognostic value of
indices of MSIMI and exercise stress-induced myocardial ischemia (ESIMI) in a
population of ischemic heart disease patients that was not confined by having a
recent positive physical stress test. Methods and results -
The Responses of Mental
Stress Induced Myocardial Ischemia to Escitalopram Treatment (REMIT) study
enrolled 310 subjects who underwent mental and exercise stress testing and were
followed annually for a median of four years. Study endpoints included time to
first and total rate of major adverse cardiovascular events, defined as all-cause
mortality and hospitalizations for cardiovascular causes. Cox and negative
binomial regression adjusting for age, sex, resting left ventricular ejection
fraction, and heart failure status were used to examine associations of indices
of MSIMI and ESIMI with study endpoints. The continuous variable of mental
stress-induced left ventricular ejection fraction change was significantly
associated with both endpoints (all p values < 0.05). For every reduction of 5%
in left ventricular ejection fraction induced by mental stress, patients had a 5%
increase in the probability of a major adverse cardiovascular event at the median
follow-up time and a 20% increase in the number of major adverse cardiovascular
events endured over the follow-up period of six years. Indices of ESIMI did not
predict endpoints ( ps > 0.05). Conclusion In patients with stable ischemic heart
disease, mental, but not exercise, stress-induced left ventricular ejection
fraction change significantly predicts risk of future adverse cardiovascular events.

Langue : ANGLAIS