Mental stress-induced left ventricular dysfunction and adverse outcome in ischemic heart disease patients

Julia L. Sun, Stephen H. Boyle, Zainab Samad, Michael A. Babyak, Jennifer L. Wilson, Cynthia Kuhn, Richard C. Becker, Thomas L. Ortel, Redford B. Williams, Joseph G. Rogers, Christopher M. O'Connor, Eric J. Velazquez, Wei Jiang

Research output: Contribution to journalArticlepeer-review

19 Citations (Scopus)


Aims: Mental stress-induced myocardial ischemia (MSIMI) occurs in up to 70% of patients with clinically stable ischemic heart disease and is associated with increased risk of adverse prognosis. We aimed to examine the prognostic value of indices of MSIMI and exercise stress-induced myocardial ischemia (ESIMI) in a population of ischemic heart disease patients that was not confined by having a recent positive physical stress test. Methods and results: The Responses of Mental Stress Induced Myocardial Ischemia to Escitalopram Treatment (REMIT) study enrolled 310 subjects who underwent mental and exercise stress testing and were followed annually for a median of four years. Study endpoints included time to first and total rate of major adverse cardiovascular events, defined as all-cause mortality and hospitalizations for cardiovascular causes. Cox and negative binomial regression adjusting for age, sex, resting left ventricular ejection fraction, and heart failure status were used to examine associations of indices of MSIMI and ESIMI with study endpoints. The continuous variable of mental stress-induced left ventricular ejection fraction change was significantly associated with both endpoints (all p values<0.05). For every reduction of 5% in left ventricular ejection fraction induced by mental stress, patients had a 5% increase in the probability of a major adverse cardiovascular event at the median follow-up time and a 20% increase in the number of major adverse cardiovascular events endured over the follow-up period of six years. Indices of ESIMI did not predict endpoints (ps>0.05). Conclusion: In patients with stable ischemic heart disease, mental, but not exercise, stress-induced left ventricular ejection fraction change significantly predicts risk of future adverse cardiovascular events.

Original languageEnglish
Pages (from-to)591-599
Number of pages9
JournalEuropean Journal of Preventive Cardiology
Issue number6
Publication statusPublished - Apr 2017
Externally publishedYes


  • Ejection fraction
  • Exercise stress
  • Mental stress


Dive into the research topics of 'Mental stress-induced left ventricular dysfunction and adverse outcome in ischemic heart disease patients'. Together they form a unique fingerprint.

Cite this