Mental Stress Ischemia: Prognosis and Genetic Influences

Summary

Principal Investigator: Arshed A Quyyumi
Abstract: DESCRIPTION (provided by applicant): The overall long range goal of this program project is to generate novel data on the causal mechanisms of mental stress ischemia (MSI), to identify new endophenotypes susceptible to MSI, to determine the clinical importance of MSI in a diverse and contemporary patient population with stable coronary artery disease (CAD), and to identify genotype variants that may put individuals at increased risk for MSI. This program project will consist of three projects and three cores. We will study 650 participants with broadly defined CAD. We propose to examine rain, genetic, vascular, hormonal, and behavioral correlates of MSI and their potential role in future cardiac events. This project will lead to new knowledge related to the mechanisms of MSI which could have tremendous influence on the ability to successfully treat this phenomenon. Project 1: Mental Stress Ischemia: Prognosis and Genetic Influences. Dr. Sheps, PI, will study the relationship between MSI and cardiovascular outcomes and the role of genetic factors on MSI susceptibility. He will perform exercise and mental stress testing, genetic studies and follow up studies on all 650 patients. Project 2: Vascular Responses During Mental Stress. Dr. Arshed Quyyumi, PI, will study vascular mechanisms, i.e., abnormal vascular reactivity and pro-inflammatory responses as they relate to mental stress and MSI. He will examine peripheral vascular function in the same cohort of patients during mental stress, and coronary vascular responses in a sub group of 80 patients. Studies will be repeated at year two of follow-up to assess potential influences on disease progression. Project 3: Depression and Mental Stress Ischemia: Brain Mechanisms. Dr. Viola Vaccarino, PI, will study brain mechanisms, with a focus on neurobiological pathways related to depression. She will examine the link between depression and MSI in the whole PPG population and will perform brain imaging and neuroendocrine assessments in a subgroup of 160 patients. These studies will be supported by an Administrative and Laboratory Core, an Imaging Core, and a Biostatistics and Data Management Core. The knowledge gained from this program project should lead to PUBLIC HEALTH RELEVANCE: This research has potential to identify genetic variants, vascular abnormalities and neuropsychological features that place individuals at high risk for development of mental stress ischemia and therefore adverse outcomes. If successful, this research will contribute in significant ways to the development of the new field of personalized medicine in which individuals at high risk can be identified early in the disease process and targeted for preventative interventions.
Funding Period: 2010-09-01 - 2015-11-30
more information: NIH RePORT

Top Publications

  1. pmc Myocardial ischemia during mental stress: role of coronary artery disease burden and vasomotion
    Ronnie Ramadan
    Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA
    J Am Heart Assoc 2:e000321. 2013
  2. pmc Myocardial bridging: contemporary understanding of pathophysiology with implications for diagnostic and therapeutic strategies
    Michel T Corban
    Andreas Gruentzig Cardiovascular Center, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
    J Am Coll Cardiol 63:2346-55. 2014
  3. pmc Sex differences in mental stress-induced myocardial ischemia in young survivors of an acute myocardial infarction
    Viola Vaccarino
    From the Department of Epidemiology V V, A J S, C R, I I, P P, P R, Rollins School of Public Health, Emory University, Atlanta, Georgia Departments of Medicine V V, A J S, A s, L D M, C K, Radiology J A N, P R, and Psychiatry and Behavioral Sciences J D B, Emory University School of Medicine, Atlanta, Georgia Department of Internal Medicine A S, Tuba City Regional Healthcare Corporation, Tuba City, Arizona Division of Nephrology L D M, Hospital Universitario Ruiz y Paez, Universidad de Oriente, Bolivar, Venezuela Division of Nephrology C K, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil and Mazankowski Alberta Heart Institute P R, University of Alberta, Edmonton, Alberta, Canada
    Psychosom Med 76:171-80. 2014
  4. pmc Meta-analysis of mental stress-induced myocardial ischemia and subsequent cardiac events in patients with coronary artery disease
    Jingkai Wei
    Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
    Am J Cardiol 114:187-92. 2014

Detail Information

Publications6

  1. pmc Myocardial ischemia during mental stress: role of coronary artery disease burden and vasomotion
    Ronnie Ramadan
    Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA
    J Am Heart Assoc 2:e000321. 2013
    ..We hypothesized that compared with exercise/pharmacological stress-induced myocardial ischemia (PSIMI) that is secondary to the atherosclerotic burden of CAD, MSIMI is primarily due to vasomotor changes...
  2. pmc Myocardial bridging: contemporary understanding of pathophysiology with implications for diagnostic and therapeutic strategies
    Michel T Corban
    Andreas Gruentzig Cardiovascular Center, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
    J Am Coll Cardiol 63:2346-55. 2014
    ..This review presents our understanding of the pathophysiology of myocardial bridging and describes prevailing diagnostic modalities and therapeutic options for this challenging clinical entity...
  3. pmc Sex differences in mental stress-induced myocardial ischemia in young survivors of an acute myocardial infarction
    Viola Vaccarino
    From the Department of Epidemiology V V, A J S, C R, I I, P P, P R, Rollins School of Public Health, Emory University, Atlanta, Georgia Departments of Medicine V V, A J S, A s, L D M, C K, Radiology J A N, P R, and Psychiatry and Behavioral Sciences J D B, Emory University School of Medicine, Atlanta, Georgia Department of Internal Medicine A S, Tuba City Regional Healthcare Corporation, Tuba City, Arizona Division of Nephrology L D M, Hospital Universitario Ruiz y Paez, Universidad de Oriente, Bolivar, Venezuela Division of Nephrology C K, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil and Mazankowski Alberta Heart Institute P R, University of Alberta, Edmonton, Alberta, Canada
    Psychosom Med 76:171-80. 2014
    ..We sought to examine whether mental stress-induced myocardial ischemia (MSIMI), but not exercise-induced ischemia, is more common in young women with previous myocardial infarction (MI) than in men...
  4. pmc Meta-analysis of mental stress-induced myocardial ischemia and subsequent cardiac events in patients with coronary artery disease
    Jingkai Wei
    Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
    Am J Cardiol 114:187-92. 2014
    ..Whether this increased risk is generalizable to the CAD population at large and varies in patient subgroups warrant further investigation...