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

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Author information

Affiliations

  • 1. Department of Epidemiology (J.O., V.V., A.S.S., L.Y.L., B.D.P., P.R., Y.V.S., L.C., A.J.S.), Rollins School of Public Health, Emory University, Atlanta, GA.
      Authors
    • Osei J 1
    • Vaccarino V 1, 2
    • Shah AS 1
    • Li LY 1
    • Pearce BD 1
    • Raggi P 1
    • Sun YV 1
    • Correia L 1
    • Shah AJ 1, 2
    (9 authors)
  • 2. Department of Medicine, Division of Cardiology, Emory Clinical Cardiovascular Research Institute (V.V., M.W., A.A.Q., H.A., G.H., O.D., T.R., L.S., A.J.S.), Emory University School of Medicine, Atlanta, GA.
      Authors
    • Vaccarino V 1, 2
    • Wang M 2
    • Quyyumi AA 2
    • Ahmed H 2
    • Haddad G 2
    • Daaboul O 2
    • Roberts T 2
    • Stefanos L 2
    • Shah AJ 1, 2
    (9 authors)
  • 3. Division of Cardiology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (R.L.).
      Authors
    • Lampert R 3
    (1 author)
  • 4. Department of Biostatistics and Bioinformatics (Y.-A.K., M.K.), Rollins School of Public Health, Emory University, Atlanta, GA.
      Authors
    • Ko YA 4
    • Kutner M 4
    (2 authors)
  • 5. Department of Radiology and Imaging Sciences (E.V.G., M.P.), Emory University School of Medicine, Atlanta, GA.
      Authors
    • Garcia EV 5
    • Piccinelli M 5
    (2 authors)
    • Show all (6)

ORCIDs linked to this article

Show all (16)

Circulation. Cardiovascular Imaging, 13 Jun 2024, 17(6):e016596
https://doi.org/10.1161/circimaging.124.016596 PMID: 38868952 

A comment on this article appears in "Stressing the Importance of Autonomic Nervous System Dysfunction." Circ Cardiovasc Imaging. 2024 Jun;17(6):e017028. doi: 10.1161/CIRCIMAGING.124.017028.
Free full text available after 13 Jun 2025

Abstract 

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.

Full text links 

Read article at publisher's site: https://doi.org/10.1161/circimaging.124.016596

References 

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Funding 

Funders who supported this work.

NCATS NIH HHS (3)

NHLBI NIH HHS (6)

NIMH NIH HHS (1)