Potential predictors for mental stress-induced myocardial ischemia in patients with coronary artery disease
10.1097/CM9.0000000000000260
- Author:
Mei-Yan LIU
1
;
Ya YANG
2
;
Li-Jun ZHANG
1
;
Li-Hong PU
2
;
Dong-Fang HE
1
;
Jian-Yang LIU
1
;
Adam HAFEEZ
3
;
Yu-Chuan DING
4
;
Huan MA
5
;
Qing-Shan GENG
5
Author Information
1. Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
2. Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
3. Deparment of Internal Medicine, Beaumont Health affiliated with Oakland University William Beaumont School of Medicine, Royal Oak, MI 48201, USA
4. Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI 48201, USA
5. Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510100, China
- Publication Type:Journal Article
- Keywords:
Coronary artery disease;
Depression;
Anxiety;
Blood pressure;
Biomarkers
- From:
Chinese Medical Journal
2019;132(12):1390-1399
- CountryChina
- Language:English
-
Abstract:
Background:Mental stress-induced myocardial ischemia (MSIMI) is closely associated with adverse cardiac events in patients with coronary artery disease (CAD) and we aimed to determine whether biomarkers and blood pressure could be potential predictors of MSIMI.
Methods:This study enrolled 82 patients with documented CAD between June 1, 2017 and November 9, 2017. Patient blood samples were obtained at resting period and at the end of mental arithmetic. Then, patients were assigned to MSIMI positive group and MSIMI negative group. The main statistical methods included linear regression, receiver operating characteristic (ROC) curves, and logistic regression.
Results:Patients with CAD with MSIMI had significantly greater median resting N-terminal pro-brain natriuretic peptide (NT-proBNP, 141.02 [45.85–202.76] pg/mL vs. 57.95 [27.06–117.64] pg/mL; Z = -2.23, P = 0.03) and mean systolic blood pressure (SBP) (145.56 ± 16.87 mmHg vs. 134.92 ± 18.16 mmHg, Z = -2.13, P = 0.04) when compared with those without MSIMI. After 5-min mental stress task, those who developed MSIMI presented higher elevation of median post-stressor high sensitivity cardiac troponin I (hs-cTnI, 0.020 [0.009–0.100] ng/mL vs. 0.009 [0.009–0.010] ng/mL; Z = -2.45, P = 0.01), post-stressor NT-proBNP (138.96 [39.93–201.56] pg/mL vs. 61.55 [25.66–86.50] pg/mL; Z = -2.15, P = 0.03) compared with those without MSIMI. Using the ROC curves, and after the adjustment for basic characteristics, the multiple logistic regression analysis showed that patients presenting a post-stressor hs-cTnI ≥ 0.015 ng/mL had seven-fold increase in the risk of developing MSIMI (odds ratio [OR]: 7.09; 95% confidence interval [CI]: 1.65–30.48; P = 0.009), a rest NT-proBNP ≥ 80.51 pg/mL had nearly eight-fold increase (OR: 7.85; 95% CI: 1.51–40.82; P = 0.014), a post-stressor NT-proBNP ≥ 98.80 pg/mL had 35-fold increase (OR: 34.96; 95% CI: 3.72– 328.50; P = 0.002), a rest SBP ≥ 129.50 mmHg had 11-fold increase (OR: 11.42; 95% CI: 1.21–108.17; P = 0.034).
Conclusions:The present study shows that CAD patients with higher hs-cTnI level, and/or greater NT-proBNP and/or SBP are at higher risk of suffering from MSIMI when compared with those without MSIMI, indicating that hs-cTnI, NT-proBNP, SBP might be potential predictors of MSIMI.
