CV Response to Mental Stress:Mechanistic Considerations

CV 对精神压力的反应：机制考虑

• 批准号: 7090816
• 负责人: Robert Soufer
• 金额: $ 31.21万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-07-01 至 2008-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7090816
• 关键词: clinical research; echocardiography; exercise; heart function; hemodynamics; human subject; myocardial ischemia /hypoxia; patient oriented research; perfusion; peripheral blood vessel; psychological stressor; single photon emission computed tomography

DESCRIPTION (provided by applicant): It is presumed that mental stress induced regional wall motion abnormalities and/or a decrement in left ventricular performance as measured by LVEF are a result of ischemia. Mental stress induced ischemia (MSI) is presumed to be a result of reduced regional coronary blood flow to the extent that myocardial demand is not adequately addressed. However there are several physiologic factors, which are specific to psychological stress, that confound a single measurement as a suitable gold standard and/or physiologic signature for MSI. Most notably, recent studies from the PIMI trial and our group have demonstrated a decrement in LV performance in normal subjects in response to MS. Furthermore, these studies and others have demonstrated a concomitant increase in peripheral vascular resistance (PVR). This increase in PVR differs from stress exercise and may reflect differences in the peripheral sympathetic response. This may alter the cardiac response and the attendant specificity of a given measurement as a marker of ischemia. Our group and others have demonstrated, that a reduced blood flow response to mental stress may occur in epicardial vessels which do not demonstrate significant coronary artery disease. The importance of identifying the factors that are specific to the myocardial response to MSI is central to ongoing and future studies that pursue the prognostic and clinical factors of psychologically mediated mental stress. The overall aim of this investigation is to identify the relationship between myocardial flow, function and peripheral hemodynamics that is most specific for ischemia during mental stress. We hypothesize that those subjects with a decrement in myocardial flow and/or function during mental stress that is not attributable to the associated hemodynamic response alone, will have a prognosis worse than predicted by their standard exercise/dipyridamole perfusion study. We will study 200 patients with chronic CAD who have had a recent abnormal myocardial perfusion study. These patients will undergo simultaneous echocardiography, myocardial perfusion SPECT and assessment of peripheral arterial tone at rest and during a mentally stressful task (anger recall, which is robust and reproducible). Regional and global LV function data, myocardial perfusion and hemodynamics in these subjects during rest and stress will be assessed and subjects will be categorized according to their degree of functional coronary perfusion, and hemodynamic response. These data will be compared to their predicted cardiovascular outcome as based upon the widely accepted criteria by their initial exercise/dipyridamole myocardial perfusion studies.

描述（由申请人提供）：假定精神压力引起的区域壁运动异常和/或通过LVEF测量的左心室性能降低是缺血的结果。精神压力引起的缺血（MSI）被认为是降低区域冠状动脉血液流量的结果，以至于心肌需求无法充分解决。但是，有几种特定于心理压力的生理因素，它们将单个测量值视为适合MSI的合适的金标准和/或生理签名。最值得注意的是，PIMI试验和我们的小组的最新研究表明，正常受试者响应MS的LV性能降低。此外，这些研究和其他研究表明外周血管耐药性（PVR）随之增加。 PVR的这种增加与压力运动不同，可能反映了周围交感神经反应的差异。这可能会改变给定测量作为缺血标志的心脏反应和随之而来的特异性。我们的小组和其他人已经证明，心外膜血管可能会出现对精神压力的血流反应减少，而心外膜血管可能没有表现出明显的冠状动脉疾病。确定对心肌反应特定因素的重要性对于正在进行的和未来的研究至关重要，这些研究追求心理介导的精神压力的预后和临床因素。这项研究的总体目的是确定心肌流动，功能和外周血流动力学之间的关系，这对于精神压力期间最特定。我们假设那些在心理压力下降低心肌流动和/或功能的受试者仅归因于相关的血液动力学反应，其预后将比其标准运动/二吡啶胺灌注研究所预测的要差。我们将研究200例慢性CAD患者，他们最近进行了心肌灌注研究异常。这些患者将同时进行超声心动图，心肌灌注SPECT和在静止和精神压力的任务中评估外周动脉张力（愤怒回忆，这是可靠且可重复的）。将在休息和压力期间这些受试者中的区域和全球LV功能数据，心肌灌注和血液动力学评估，并将根据其功能性冠状动脉灌注程度和血液动力学反应进行分类。这些数据将与其预测的心血管结局进行比较，因为他们的初始运动/二吡啶胺心肌灌注研究广泛接受的标准。