Stress-Induced Autonomic Dysfunction is Associated With Mental Stress-Induced Myocardial Ischemia in Patients With Coronary Artery Disease.

Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 101479935 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1942-0080 (Electronic) Linking ISSN: 19419651 NLM ISO Abbreviation: Circ Cardiovasc Imaging Subsets: MEDLINE

Original Publication: Hagerstown, MD Lippincott Williams & Wilkins

Coronary Artery Disease*/physiopathology ; Coronary Artery Disease*/complications ; Coronary Artery Disease*/psychology ; Heart Rate*/physiology ; Stress, Psychological*/complications ; Stress, Psychological*/physiopathology ; Autonomic Nervous System*/physiopathology ; Myocardial Ischemia*/physiopathology ; Myocardial Ischemia*/complications ; Myocardial Ischemia*/diagnosis ; Electrocardiography, Ambulatory*; Humans ; Female ; Male ; Middle Aged ; Aged ; Risk Factors ; Autonomic Nervous System Diseases/physiopathology ; Autonomic Nervous System Diseases/diagnosis ; Autonomic Nervous System Diseases/etiology

Background: Mental stress-induced myocardial ischemia (MSIMI) is associated with adverse cardiovascular outcomes in individuals with coronary artery disease, but the mechanisms underlying this phenomenon are unknown. We examined the relationship between stress-induced autonomic dysfunction, measured by low heart rate variability (HRV) in response to stress, and MSIMI in patients with stable coronary artery disease. We hypothesized that stress-induced autonomic dysfunction is associated with higher odds of MSIMI.
Methods: In 735 participants with stable coronary artery disease, we measured high- and low-frequency HRV in 5-minute intervals before and during a standardized laboratory-based speech stressor using Holter monitoring. HRV at rest and stress were categorized into low HRV (first quartile) versus high HRV (second to fourth quartiles); the low category was used as an indicator of autonomic dysfunction. Multivariable logistic regression models were used to examine the association of autonomic dysfunction with MSIMI.
Results: The mean age was 58 (SD, ±10) years, 35% were women, 44% were Black participants, and 16% developed MSIMI. Compared with high HRV during stress, low HRV during stress (both high and low frequencies) was associated with higher odds of MSIMI after adjusting for demographic and clinical factors (odds ratio for high-frequency HRV, 2.1 [95% CI, 1.3-3.3]; odds ratio for low-frequency HRV, 2.1 [95% CI, 1.3-3.3]). Low-frequency HRV at rest was also associated with MSIMI but with slightly reduced effect estimates.
Conclusions: In individuals with coronary artery disease, mental stress-induced autonomic dysfunction may be a mechanism implicated in the causal pathway of MSIMI.
Competing Interests: Disclosures None.

Comment in: Circ Cardiovasc Imaging. 2024 Jun;17(6):e017028. doi: 10.1161/CIRCIMAGING.124.017028. (PMID: 38868943)

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K24 HL077506 United States HL NHLBI NIH HHS; T32 HL130025 United States HL NHLBI NIH HHS; K23 HL127251 United States HL NHLBI NIH HHS; R01 HL155711 United States HL NHLBI NIH HHS; UL1 TR000454 United States TR NCATS NIH HHS; UL1 TR002378 United States TR NCATS NIH HHS; K24 MH076955 United States MH NIMH NIH HHS; P01 HL101398 United States HL NHLBI NIH HHS; KL2 TR000455 United States TR NCATS NIH HHS; R01 HL109413 United States HL NHLBI NIH HHS

Keywords: coronary artery disease; heart rate variability; myocardial ischemia; stress, psychological

Date Created: 20240613 Date Completed: 20240618 Latest Revision: 20240623

20240623

PMC11187646

10.1161/CIRCIMAGING.124.016596

38868952