Copyright © 2003 by the European Society of Cardiology.
Review article
Systematic review of mental stress-induced myocardial ischaemia
Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
* Corresponding author. Tel.: +44-20-7679-5636; fax: +44-20-7916-8542
revised 5 August 2002; accepted 7 August 2002
Key Words: Mental • Stress • Myocardial • Ischaemia
| The first 150 words of the full text of this article appear below. |
1. Introduction
There is growing evidence that psychosocial stress can influence the natural history of coronary heart disease.1 Epidemiological studies indicate that psychosocial factors both contribute to the development of coronary artery disease (CAD), and increase risk of cardiac dysfunction and the likelihood of cardiac events in susceptible patients with established disease.2,3 An important method of assessing effects on cardiac function is by measuring transient ischaemic responses to standardized mental stress tests. Mental stress-induced myocardial ischaemia (MSIMI) is analogous to exercise stress ischaemia, except that the stimulus is psychological rather than physical. MSIMI has been studied with a number of different imaging techniques and with a range of stressful stimuli. But several investigations have involved small numbers of patients, and the medication status of patients has been variable. This has resulted in diverse findings concerning the prevalence of MSIMI, the conditions in which it is elicited, the type of patients who are
2. Methods
3. Incidence of mental stress-induced myocardial ischaemia
4. Studies involving ECG assessment
4.1. Studies using radionuclide ventriculography
4.2. Radionuclide studies involving assessment of perfusion
4.3. Studies using echocartography
4.4. Studies using the nuclear VEST
4.5. Studies involving positron emission tomography (PET)
4.6. Summary of trial data
5. Mechanisms underlying mental stress-induced myocardial ischaemia
5.1. Haemodynamic responses and mental stress
5.2. Coronary artery vasomotor responses
5.3. Psychological and central nervous system factors
6. Clinical significance of mental stress-induced ischaemia
6.1. Association with severity of coronary artery disease
6.2. Laboratory mental stress and ambulatory ischaemia
6.3. The prognostic significance of mental stress-induced ischaemia
7. Limitations in the literature and unresolved issues
8. Conclusions
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