Cardiovascular and Circulatory Responses to Acute Mental Stress Among Individuals With Ischemic Cardiomyopathy.

OBJECTIVE

We studied responses to acute mental stress in individuals with stable coronary artery disease (CAD) with and without heart failure with reduced ejection fraction (HFrEF).

METHODS

Individuals with stable CAD ( N = 313, 45 with HFrEF) underwent a laboratory-based mental stress. HFrEF was defined as an ejection fraction of <40%. Hemodynamic reactivity and vasoconstriction during mental stress were evaluated using changes in systolic blood pressure and peripheral arterial tonometry, respectively. Immune function was assessed by measuring changes in interleukin-6 (IL-6) and circulating progenitor cell counts enumerated using flow cytometry of CD34-expressing mononuclear cells before and 90 minutes after mental stress.

RESULTS

During the mental stress testing, patients in the HFrEF exhibited a smaller (blunted) increase in systolic blood pressure compared with the non HFrEF group (30.4 ± 14.1 vs 41.9 ± 16.1 mm Hg, p < .001), greater vasoconstriction (PAT ratio 0.69 ± 0.30 vs 0.83 ± 0.40, p = .02), a larger increase in IL-6 levels (0.91 ± 0.11 vs 0.42 ± 0.14 pg/mL, p = .01), and larger increases in circulating progenitor cell counts (0.68 ± 0.12 vs 0.22 ± 0.11 cell/L, p = .009). After adjustment for demographic and traditional risk factors, each of these 4 maladaptive stress responses remained independently associated with the presence of HFrEF.

CONCLUSIONS

Among individuals with stable CAD, the presence of HFrEF was independently associated with a blunted systolic blood pressure response, greater vasoconstriction, increased inflammation, and enhanced progenitor cell mobilization with mental stress, a response that is associated with adverse long-term outcomes.