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The Relation of Psychosocial Distress With Myocardial Perfusion and Stress-Induced Myocardial Ischemia

Pimple, Pratik, MBBS, MPH; Hammadah, Muhammad, MD; Wilmot, Kobina, MD, MSCR; Ramadan, Ronnie, MD; Al Mheid, Ibhar, MD; Levantsevych, Oleksiy, MD; Sullivan, Samaah, PhD; Lima, Bruno B., MD, PhD; Kim, Jeong Hwan, MD; Garcia, Ernest V., PhD; Nye, Jonathon, PhD; Shah, Amit J., MD, MSCR; Ward, Laura, MPH; Raggi, Paolo, MD; Bremner, J. Douglas, MD; Hanfelt, John, PhD; Lewis, Tené T., PhD; Quyyumi, Arshed A., MD; Vaccarino, Viola, MD, PhD

doi: 10.1097/PSY.0000000000000674

Objective Mental stress–induced myocardial ischemia is a frequent phenomenon in patients with coronary artery disease (CAD). The link between an integrated measure of chronic psychosocial distress and mental stress–induced myocardial ischemia, and whether it differs by sex, has not been examined before.

Methods We used latent class analysis to derive a composite measure of psychosocial distress integrating scales of depression, posttraumatic stress, anxiety, anger, hostility, and perceived stress in 665 individuals with stable CAD. Participants underwent myocardial perfusion imaging with mental stress and perfusion defects were quantified at rest (summed rest score), with mental stress (summed stress score), and their difference (summed difference score), the latter being an index of inducible ischemia.

Results The M (SD) age was 63 (9) years, and 185 (28%) were women. Latent class analysis characterized the study sample into four distinct classes of incremental psychosocial distress. In women, class 4 (highest distress) had an adjusted 4.0-point higher summed rest score (95% confidence interval = 0.2–7.7) as compared with class 1 (lowest distress), whereas no difference was observed in men (−0.87 points, 95% confidence interval = −3.74 to 1.99, p = .04 for interaction). There was no association between the psychosocial distress latent variable and summed difference score in either women or men.

Conclusions Among patients with CAD, a higher level of psychosocial distress is not associated with mental stress ischemia, but it is associated with more resting (fixed) perfusion abnormalities in women only, as well as with blunted hemodynamic response to mental stress in both men and women.

From the Department of Epidemiology (Pimple, Sullivan, Shah, Lewis, Vaccarino), Rollins School of Public Health, Emory University; Department of Medicine (Hammadah, Wilmot, Ramadan, Al Mheid, Levantsevych, Lima, Kim, Shah, Quyyumi, Vaccarino), Division of Cardiology, Emory University; Department of Radiology & Imaging Science (Garcia, Nye), Emory University School of Medicine; Department of Biostatistics & Bioinformatics (Ward, Hanfelt), Rollins School of Public Health, Emory University, Atlanta, Georgia; Mazankowski Alberta Heart Institute (Raggi), University of Alberta, Edmonton, Alberta, Canada; and Department of Psychiatry and Behavioral Sciences (Bremner), Emory University School of Medicine, Atlanta, Georgia.

Supplemental Content

Address correspondence to Pratik Pimple, MBBS, MPH, Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, CA 30322. E-mail:

All the authors had access to the data and a significant contribution in either data collection or design, data analysis, and execution of the article. All authors contributed to the writing of the article.

Received for publication January 8, 2018; revision received December 8, 2018.

Copyright © 2019 by American Psychosomatic Society
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