Muhammad Hammadah1, Ibhar Al Mheid1, Kobina Wilmot1, Ronnie Ramadan1, Ayman Alkhoder1, Malik Obideen1, Naser Abdelhadi1, Shuyang Fang2, Ijeoma Ibeanu3, Pratik Pimple3, Heval Mohamed Kelli1, Amit J Shah2, Brad Pearce3, Yan Sun3, Ernest V Garcia4, Michael Kutner5, Qi Long3, Laura Ward5, J Douglas Bremner6, Fabio Esteves4, Paolo Raggi7, David Sheps8, Viola Vaccarino2, Arshed A Quyyumi9. 1. Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia. 2. Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia. 3. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia. 4. Department of Radiology, Emory University School of Medicine, Atlanta, Georgia. 5. Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia. 6. Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia. 7. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Department of Radiology, Emory University School of Medicine, Atlanta, Georgia; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada. 8. Department of Epidemiology, University of Florida, Gainesville, Florida. 9. Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia. Electronic address: aquyyum@emory.edu.
Abstract
OBJECTIVES: This study sought to investigate whether patients with mental stress-induced myocardial ischemia will have high resting and post-mental stress high-sensitivity cardiac troponin I (hs-cTnI). BACKGROUND: Hs-cTnI is a marker of myocardial necrosis, and its elevated levels are associated with adverse outcomes. Hs-cTnI levels may increase with exercise in patients with coronary artery disease. Mental stress-induced myocardial ischemia is also linked to adverse outcomes. METHODS: In this study, 587 patients with stable coronary artery disease underwent technetium Tc 99m sestamibi-single-photon emission tomography myocardial perfusion imaging during mental stress testing using a public speaking task and during conventional (pharmacological/exercise) stress testing as a control condition. Ischemia was defined as new/worsening impairment in myocardial perfusion using a 17-segment model. RESULTS: The median hs-cTnI resting level was 4.3 (interquartile range [IQR]: 2.9 to 7.3) pg/ml. Overall, 16% and 34.8% of patients developed myocardial ischemia during mental and conventional stress, respectively. Compared with those without ischemia, median resting hs-cTnI levels were higher in patients who developed ischemia either during mental stress (5.9 [IQR: 3.9 to 8.3] pg/ml vs. 4.1 [IQR: 2.7 to 7.0] pg/ml; p < 0.001) or during conventional stress (5.4 [IQR: 3.9 to 9.3] pg/ml vs. 3.9 [IQR: 2.5 to 6.5] pg/ml; p < 0.001). Patients with high hs-cTnI (cutoff of 4.6 pg/ml for men and 3.9 pg/ml for women) had greater odds of developing mental (odds ratio [OR]: 2.4; 95% confidence interval [CI]: 1.5 to 3.9; p < 0.001) and conventional (OR: 2.4; 95% CI: 1.7 to 3.4; p < 0.001) stress-induced ischemia. Although there was a significant increase in 45-min post-treadmill exercise hs-cTnI levels in those who developed ischemia, there was no significant increase after mental or pharmacological stress test. CONCLUSIONS: In patients with coronary artery disease, myocardial ischemia during either mental stress or conventional stress is associated with higher resting levels of hs-cTnI. This suggests that hs-cTnI elevation is an indicator of chronic ischemic burden experienced during everyday life. Whether elevated hs-cTnI levels are an indicator of adverse prognosis beyond inducible ischemia or whether it is amenable to intervention requires further investigation.
OBJECTIVES: This study sought to investigate whether patients with mental stress-induced myocardial ischemia will have high resting and post-mental stress high-sensitivity cardiac troponin I (hs-cTnI). BACKGROUND: Hs-cTnI is a marker of myocardial necrosis, and its elevated levels are associated with adverse outcomes. Hs-cTnI levels may increase with exercise in patients with coronary artery disease. Mental stress-induced myocardial ischemia is also linked to adverse outcomes. METHODS: In this study, 587 patients with stable coronary artery disease underwent technetium Tc 99msestamibi-single-photon emission tomography myocardial perfusion imaging during mental stress testing using a public speaking task and during conventional (pharmacological/exercise) stress testing as a control condition. Ischemia was defined as new/worsening impairment in myocardial perfusion using a 17-segment model. RESULTS: The median hs-cTnI resting level was 4.3 (interquartile range [IQR]: 2.9 to 7.3) pg/ml. Overall, 16% and 34.8% of patients developed myocardial ischemia during mental and conventional stress, respectively. Compared with those without ischemia, median resting hs-cTnI levels were higher in patients who developed ischemia either during mental stress (5.9 [IQR: 3.9 to 8.3] pg/ml vs. 4.1 [IQR: 2.7 to 7.0] pg/ml; p < 0.001) or during conventional stress (5.4 [IQR: 3.9 to 9.3] pg/ml vs. 3.9 [IQR: 2.5 to 6.5] pg/ml; p < 0.001). Patients with high hs-cTnI (cutoff of 4.6 pg/ml for men and 3.9 pg/ml for women) had greater odds of developing mental (odds ratio [OR]: 2.4; 95% confidence interval [CI]: 1.5 to 3.9; p < 0.001) and conventional (OR: 2.4; 95% CI: 1.7 to 3.4; p < 0.001) stress-induced ischemia. Although there was a significant increase in 45-min post-treadmill exercise hs-cTnI levels in those who developed ischemia, there was no significant increase after mental or pharmacological stress test. CONCLUSIONS: In patients with coronary artery disease, myocardial ischemia during either mental stress or conventional stress is associated with higher resting levels of hs-cTnI. This suggests that hs-cTnI elevation is an indicator of chronic ischemic burden experienced during everyday life. Whether elevated hs-cTnI levels are an indicator of adverse prognosis beyond inducible ischemia or whether it is amenable to intervention requires further investigation.
Authors: Rohit M Oemrawsingh; Jin M Cheng; Héctor M García-García; Isabella Kardys; Ron H N van Schaik; Evelyn Regar; Robert-Jan van Geuns; Patrick W Serruys; Eric Boersma; K Martijn Akkerhuis Journal: Atherosclerosis Date: 2016-02-15 Impact factor: 5.162
Authors: Jingkai Wei; Cherie Rooks; Ronnie Ramadan; Amit J Shah; J Douglas Bremner; Arshed A Quyyumi; Michael Kutner; Viola Vaccarino Journal: Am J Cardiol Date: 2014-05-01 Impact factor: 2.778
Authors: Mads Ersbøll; Fawaz Al Enezi; Zainab Samad; Brenda Sedberry; Stephen H Boyle; Christopher O'Connor; Wei Jiang; Eric J Velazquez Journal: JACC Cardiovasc Imaging Date: 2014-03-13
Authors: Brendan M Everett; Tanja Zeller; Robert J Glynn; Paul M Ridker; Stefan Blankenberg Journal: Circulation Date: 2015-03-30 Impact factor: 29.690
Authors: Tanja Zeller; Hugh Tunstall-Pedoe; Olli Saarela; Francisco Ojeda; Renate B Schnabel; Tarja Tuovinen; Mark Woodward; Allan Struthers; Maria Hughes; Frank Kee; Veikko Salomaa; Kari Kuulasmaa; Stefan Blankenberg Journal: Eur Heart J Date: 2013-10-08 Impact factor: 29.983
Authors: Bruno B Lima; Muhammad Hammadah; Jeong Hwan Kim; Irina Uphoff; Amit Shah; Oleksiy Levantsevych; Zakaria Almuwaqqat; Kasra Moazzami; Samaah Sullivan; Laura Ward; Yan Sun; Michael Kutner; Yi-An Ko; David S Sheps; Agim Beshiri; Gillian Murtagh; J Douglas Bremner; Viola Vaccarino; Arshed A Quyyumi Journal: Am J Cardiol Date: 2020-09-15 Impact factor: 2.778
Authors: Muhammad Hammadah; Samaah Sullivan; Brad Pearce; Ibhar Al Mheid; Kobina Wilmot; Ronnie Ramadan; Ayman Samman Tahhan; Wesley T O'Neal; Malik Obideen; Ayman Alkhoder; Naser Abdelhadi; Heval Mohamed Kelli; Mohamad Mazen Ghafeer; Pratik Pimple; Pratik Sandesara; Amit J Shah; Kareem Mohammed Hosny; Laura Ward; Yi-An Ko; Yan V Sun; Lei Weng; Michael Kutner; J Douglas Bremner; David S Sheps; Fabio Esteves; Paolo Raggi; Viola Vaccarino; Arshed A Quyyumi Journal: Brain Behav Immun Date: 2017-10-03 Impact factor: 7.217
Authors: Ayman Samman Tahhan; Pratik Sandesara; Salim S Hayek; Muhammad Hammadah; Ayman Alkhoder; Heval M Kelli; Matthew Topel; Wesley T O'Neal; Nima Ghasemzadeh; Yi-An Ko; Mohamad Mazen Gafeer; Naser Abdelhadi; Fahad Choudhary; Keyur Patel; Agim Beshiri; Gillian Murtagh; Jonathan Kim; Peter Wilson; Leslee Shaw; Viola Vaccarino; Stephen E Epstein; Laurence Sperling; Arshed A Quyyumi Journal: J Am Heart Assoc Date: 2018-02-21 Impact factor: 5.501
Authors: Seung-Hwa Lee; Myung Soo Park; Young Bin Song; Jungchan Park; Jaeyoun Kim; Sangmin Maria Lee; Young Tak Lee Journal: PLoS One Date: 2019-06-27 Impact factor: 3.240
Authors: Muhammad Hammadah; Jeong Hwan Kim; Ayman Samman Tahhan; Bryan Kindya; Chang Liu; Yi-An Ko; Ibhar Al Mheid; Kobina Wilmot; Ronnie Ramadan; Ayman Alkhoder; Fahad Choudhary; Mohamad Mazen Gafeer; Naser Abdelhadi; Pratik Pimple; Pratik Sandesara; Bruno B Lima; Amit J Shah; Laura Ward; Michael Kutner; J Douglas Bremner; David S Sheps; Paolo Raggi; Laurence S Sperling; Viola Vaccarino; Arshed A Quyyumi Journal: Ann Intern Med Date: 2018-11-06 Impact factor: 25.391
Authors: Muhammad Hammadah; Jeong Hwan Kim; Ibhar Al Mheid; Ayman Samman Tahhan; Kobina Wilmot; Ronnie Ramadan; Ayman Alkhoder; Mohamed Khayata; Girum Mekonnen; Oleksiy Levantsevych; Yasir Bouchi; Belal Kaseer; Fahad Choudhary; Mohamad M Gafeer; Frank E Corrigan; Amit J Shah; Laura Ward; Michael Kutner; J Douglas Bremner; David S Sheps; Paolo Raggi; Viola Vaccarino; Habib Samady; Kreton Mavromatis; Arshed A Quyyumi Journal: J Am Heart Assoc Date: 2018-05-03 Impact factor: 5.501