Platelet aggregation and mental stress induced myocardial ischemia: Results from the Responses of Myocardial Ischemia to Escitalopram Treatment (REMIT) study
Background Mental stress-induced myocardial ischemia (MSIMI) is common in patients with ischemic heart disease (IHD) and associated with a poorer cardiovascular prognosis. Platelet hyperactivity is an important factor in acute coronary syndrome. This study examined associations between MSIMI and res...
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| Veröffentlicht in: | The American heart journal 2015-04, Vol.169 (4), p.496-507.e1 |
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| creator | Jiang, Wei, MD Boyle, Stephen H., PhD Ortel, Thomas L., MD, PhD Samad, Zainab, MD Velazquez, Eric J., MD Harrison, Robert W., MD Wilson, Jennifer, BA Kuhn, Cynthia, PhD Williams, Redford B., MD O’Connor, Christopher M., MD Becker, Richard C., MD |
| description | Background Mental stress-induced myocardial ischemia (MSIMI) is common in patients with ischemic heart disease (IHD) and associated with a poorer cardiovascular prognosis. Platelet hyperactivity is an important factor in acute coronary syndrome. This study examined associations between MSIMI and resting and mental stress-induced platelet activity. Methods Eligible patients with clinically stable IHD underwent a battery of 3 mental stress tests during the recruitment phase of REMIT study. MSIMI was assessed by echocardiography and electrocardiography. Ex vivo platelet aggregation in response to ADP, epinephrine, collagen, serotonin, and combinations of serotonin plus ADP, epinephrine, and collagen were evaluated as was platelet serotonin transporter expression. Results Of the 270 participants who completed mental stress testing, and had both resting and post-stress platelet aggregation evaluation , 43.33% (n = 117) met criteria for MSIMI and 18.15% (n = 49) had normal left ventricular response to stress (NLVR). The MSIMI group, relative to the NLVR groups, demonstrated heightened mental stress-induced aggregation responses, as measured by area under the curve, to collagen 10 μM (6.95[5.54] vs. -14.23[8.75].; P = 0.045), epinephrine 10 μM (12.84[4.84] vs. -6.40[7.61].; P = 0.037) and to serotonin 10 μM plus ADP 1 μM (6.64[5.29] vs. -27.34[8.34]; P < .001). The resting platelet aggregation and serotonin transporter expression, however, were not different between the two groups. Conclusions These findings suggest that the dynamic change of platelet aggregation caused by mental stress may underlie MSIMI. While the importance of these findings requires additional investigation, they raise concern given the recognized relationship between mental stress-induced platelet hyperactivity and cardiovascular events in patients with IHD. |
| doi_str_mv | 10.1016/j.ahj.2014.12.002 |
| format | Article |
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Platelet hyperactivity is an important factor in acute coronary syndrome. This study examined associations between MSIMI and resting and mental stress-induced platelet activity. Methods Eligible patients with clinically stable IHD underwent a battery of 3 mental stress tests during the recruitment phase of REMIT study. MSIMI was assessed by echocardiography and electrocardiography. Ex vivo platelet aggregation in response to ADP, epinephrine, collagen, serotonin, and combinations of serotonin plus ADP, epinephrine, and collagen were evaluated as was platelet serotonin transporter expression. Results Of the 270 participants who completed mental stress testing, and had both resting and post-stress platelet aggregation evaluation , 43.33% (n = 117) met criteria for MSIMI and 18.15% (n = 49) had normal left ventricular response to stress (NLVR). The MSIMI group, relative to the NLVR groups, demonstrated heightened mental stress-induced aggregation responses, as measured by area under the curve, to collagen 10 μM (6.95[5.54] vs. -14.23[8.75].; P = 0.045), epinephrine 10 μM (12.84[4.84] vs. -6.40[7.61].; P = 0.037) and to serotonin 10 μM plus ADP 1 μM (6.64[5.29] vs. -27.34[8.34]; P < .001). The resting platelet aggregation and serotonin transporter expression, however, were not different between the two groups. Conclusions These findings suggest that the dynamic change of platelet aggregation caused by mental stress may underlie MSIMI. While the importance of these findings requires additional investigation, they raise concern given the recognized relationship between mental stress-induced platelet hyperactivity and cardiovascular events in patients with IHD.</description><identifier>ISSN: 0002-8703</identifier><identifier>EISSN: 1097-6744</identifier><identifier>DOI: 10.1016/j.ahj.2014.12.002</identifier><identifier>PMID: 25819856</identifier><identifier>CODEN: AHJOA2</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Anxiety ; Atherosclerosis ; Blood platelets ; Blood pressure ; Cardiovascular ; Cardiovascular disease ; Citalopram - therapeutic use ; Collagen ; Drug therapy ; Electrocardiography ; Female ; Heart attacks ; Heart rate ; Humans ; Ischemia ; Laboratories ; Male ; Middle Aged ; Mortality ; Myocardial Ischemia - blood ; Myocardial Ischemia - etiology ; Platelet Aggregation - physiology ; ROC Curve ; Serotonin ; Serotonin Uptake Inhibitors - therapeutic use ; Stress ; Stress, Psychological - blood ; Stress, Psychological - complications ; Stress, Psychological - drug therapy ; Studies ; Treatment Outcome ; Variables</subject><ispartof>The American heart journal, 2015-04, Vol.169 (4), p.496-507.e1</ispartof><rights>Elsevier Inc.</rights><rights>2014 Elsevier Inc.</rights><rights>Copyright © 2014 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Apr 2015</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c549t-68035cd919a33573727a39270dfaac0bdb50e2504276faca0ae09e8f730b92e53</citedby><cites>FETCH-LOGICAL-c549t-68035cd919a33573727a39270dfaac0bdb50e2504276faca0ae09e8f730b92e53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002870314007315$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25819856$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jiang, Wei, MD</creatorcontrib><creatorcontrib>Boyle, Stephen H., PhD</creatorcontrib><creatorcontrib>Ortel, Thomas L., MD, PhD</creatorcontrib><creatorcontrib>Samad, Zainab, MD</creatorcontrib><creatorcontrib>Velazquez, Eric J., MD</creatorcontrib><creatorcontrib>Harrison, Robert W., MD</creatorcontrib><creatorcontrib>Wilson, Jennifer, BA</creatorcontrib><creatorcontrib>Kuhn, Cynthia, PhD</creatorcontrib><creatorcontrib>Williams, Redford B., MD</creatorcontrib><creatorcontrib>O’Connor, Christopher M., MD</creatorcontrib><creatorcontrib>Becker, Richard C., MD</creatorcontrib><title>Platelet aggregation and mental stress induced myocardial ischemia: Results from the Responses of Myocardial Ischemia to Escitalopram Treatment (REMIT) study</title><title>The American heart journal</title><addtitle>Am Heart J</addtitle><description>Background Mental stress-induced myocardial ischemia (MSIMI) is common in patients with ischemic heart disease (IHD) and associated with a poorer cardiovascular prognosis. Platelet hyperactivity is an important factor in acute coronary syndrome. This study examined associations between MSIMI and resting and mental stress-induced platelet activity. Methods Eligible patients with clinically stable IHD underwent a battery of 3 mental stress tests during the recruitment phase of REMIT study. MSIMI was assessed by echocardiography and electrocardiography. Ex vivo platelet aggregation in response to ADP, epinephrine, collagen, serotonin, and combinations of serotonin plus ADP, epinephrine, and collagen were evaluated as was platelet serotonin transporter expression. Results Of the 270 participants who completed mental stress testing, and had both resting and post-stress platelet aggregation evaluation , 43.33% (n = 117) met criteria for MSIMI and 18.15% (n = 49) had normal left ventricular response to stress (NLVR). The MSIMI group, relative to the NLVR groups, demonstrated heightened mental stress-induced aggregation responses, as measured by area under the curve, to collagen 10 μM (6.95[5.54] vs. -14.23[8.75].; P = 0.045), epinephrine 10 μM (12.84[4.84] vs. -6.40[7.61].; P = 0.037) and to serotonin 10 μM plus ADP 1 μM (6.64[5.29] vs. -27.34[8.34]; P < .001). The resting platelet aggregation and serotonin transporter expression, however, were not different between the two groups. Conclusions These findings suggest that the dynamic change of platelet aggregation caused by mental stress may underlie MSIMI. While the importance of these findings requires additional investigation, they raise concern given the recognized relationship between mental stress-induced platelet hyperactivity and cardiovascular events in patients with IHD.</description><subject>Anxiety</subject><subject>Atherosclerosis</subject><subject>Blood platelets</subject><subject>Blood pressure</subject><subject>Cardiovascular</subject><subject>Cardiovascular disease</subject><subject>Citalopram - therapeutic use</subject><subject>Collagen</subject><subject>Drug therapy</subject><subject>Electrocardiography</subject><subject>Female</subject><subject>Heart attacks</subject><subject>Heart rate</subject><subject>Humans</subject><subject>Ischemia</subject><subject>Laboratories</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Myocardial Ischemia - blood</subject><subject>Myocardial Ischemia - etiology</subject><subject>Platelet Aggregation - physiology</subject><subject>ROC Curve</subject><subject>Serotonin</subject><subject>Serotonin Uptake Inhibitors - therapeutic use</subject><subject>Stress</subject><subject>Stress, Psychological - blood</subject><subject>Stress, Psychological - complications</subject><subject>Stress, Psychological - drug therapy</subject><subject>Studies</subject><subject>Treatment Outcome</subject><subject>Variables</subject><issn>0002-8703</issn><issn>1097-6744</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9ks9u1DAQxiMEokvhAbggS1zaQ4L_JHECEhKqFlipFagsZ2vWmew6JPFiO5X2YXhXHHahUg-cLI9_34xnvkmSl4xmjLLyTZfBrss4ZXnGeEYpf5QsGK1lWso8f5wsaAyllaTiLHnmfRevJa_Kp8kZLypWV0W5SH597SFgj4HAdutwC8HYkcDYkAHHAD3xwaH3xIzNpDFGD1aDa0x8MV7vcDDwltyin_rgSevsQMIO58Dejh49sS25uZesThISLFl6bWIBu3cwkLVDCHNFcnG7vFmtL2PdqTk8T5600Ht8cTrPk-8fl-urz-n1l0-rqw_XqS7yOqRlRUWhm5rVIEQhheQSRM0lbVoATTfNpqDIC5pzWbaggQLSGqtWCrqpORbiPLk45t07-3NCH9QQu8O-hxHt5BUrS1kXlajqiL5-gHZ2cmP83R-KSyZZHil2pLSz3jts1d6ZAdxBMapm71Snondq9k4xrqJRUfPqlHnaDNj8U_w1KwLvjgDGUdwZdCqOEMdoi3Gog2qs-W_69w_Uujej0dD_wAP6-y6UjwL1bV6eeXdYTqkUrBC_Ad-6v-E</recordid><startdate>20150401</startdate><enddate>20150401</enddate><creator>Jiang, Wei, MD</creator><creator>Boyle, Stephen H., PhD</creator><creator>Ortel, Thomas L., MD, PhD</creator><creator>Samad, Zainab, MD</creator><creator>Velazquez, Eric J., MD</creator><creator>Harrison, Robert W., MD</creator><creator>Wilson, Jennifer, BA</creator><creator>Kuhn, Cynthia, PhD</creator><creator>Williams, Redford B., MD</creator><creator>O’Connor, Christopher M., MD</creator><creator>Becker, Richard C., MD</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20150401</creationdate><title>Platelet aggregation and mental stress induced myocardial ischemia: Results from the Responses of Myocardial Ischemia to Escitalopram Treatment (REMIT) study</title><author>Jiang, Wei, MD ; Boyle, Stephen H., PhD ; Ortel, Thomas L., MD, PhD ; Samad, Zainab, MD ; Velazquez, Eric J., MD ; Harrison, Robert W., MD ; Wilson, Jennifer, BA ; Kuhn, Cynthia, PhD ; Williams, Redford B., MD ; O’Connor, Christopher M., MD ; Becker, Richard C., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c549t-68035cd919a33573727a39270dfaac0bdb50e2504276faca0ae09e8f730b92e53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Anxiety</topic><topic>Atherosclerosis</topic><topic>Blood platelets</topic><topic>Blood pressure</topic><topic>Cardiovascular</topic><topic>Cardiovascular disease</topic><topic>Citalopram - therapeutic use</topic><topic>Collagen</topic><topic>Drug therapy</topic><topic>Electrocardiography</topic><topic>Female</topic><topic>Heart attacks</topic><topic>Heart rate</topic><topic>Humans</topic><topic>Ischemia</topic><topic>Laboratories</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Myocardial Ischemia - blood</topic><topic>Myocardial Ischemia - etiology</topic><topic>Platelet Aggregation - physiology</topic><topic>ROC Curve</topic><topic>Serotonin</topic><topic>Serotonin Uptake Inhibitors - therapeutic use</topic><topic>Stress</topic><topic>Stress, Psychological - blood</topic><topic>Stress, Psychological - complications</topic><topic>Stress, Psychological - drug therapy</topic><topic>Studies</topic><topic>Treatment Outcome</topic><topic>Variables</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jiang, Wei, MD</creatorcontrib><creatorcontrib>Boyle, Stephen H., PhD</creatorcontrib><creatorcontrib>Ortel, Thomas L., MD, PhD</creatorcontrib><creatorcontrib>Samad, Zainab, MD</creatorcontrib><creatorcontrib>Velazquez, Eric J., MD</creatorcontrib><creatorcontrib>Harrison, Robert W., MD</creatorcontrib><creatorcontrib>Wilson, Jennifer, BA</creatorcontrib><creatorcontrib>Kuhn, Cynthia, PhD</creatorcontrib><creatorcontrib>Williams, Redford B., MD</creatorcontrib><creatorcontrib>O’Connor, Christopher M., MD</creatorcontrib><creatorcontrib>Becker, Richard C., MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jiang, Wei, MD</au><au>Boyle, Stephen H., PhD</au><au>Ortel, Thomas L., MD, PhD</au><au>Samad, Zainab, MD</au><au>Velazquez, Eric J., MD</au><au>Harrison, Robert W., MD</au><au>Wilson, Jennifer, BA</au><au>Kuhn, Cynthia, PhD</au><au>Williams, Redford B., MD</au><au>O’Connor, Christopher M., MD</au><au>Becker, Richard C., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Platelet aggregation and mental stress induced myocardial ischemia: Results from the Responses of Myocardial Ischemia to Escitalopram Treatment (REMIT) study</atitle><jtitle>The American heart journal</jtitle><addtitle>Am Heart J</addtitle><date>2015-04-01</date><risdate>2015</risdate><volume>169</volume><issue>4</issue><spage>496</spage><epage>507.e1</epage><pages>496-507.e1</pages><issn>0002-8703</issn><eissn>1097-6744</eissn><coden>AHJOA2</coden><abstract>Background Mental stress-induced myocardial ischemia (MSIMI) is common in patients with ischemic heart disease (IHD) and associated with a poorer cardiovascular prognosis. Platelet hyperactivity is an important factor in acute coronary syndrome. This study examined associations between MSIMI and resting and mental stress-induced platelet activity. Methods Eligible patients with clinically stable IHD underwent a battery of 3 mental stress tests during the recruitment phase of REMIT study. MSIMI was assessed by echocardiography and electrocardiography. Ex vivo platelet aggregation in response to ADP, epinephrine, collagen, serotonin, and combinations of serotonin plus ADP, epinephrine, and collagen were evaluated as was platelet serotonin transporter expression. Results Of the 270 participants who completed mental stress testing, and had both resting and post-stress platelet aggregation evaluation , 43.33% (n = 117) met criteria for MSIMI and 18.15% (n = 49) had normal left ventricular response to stress (NLVR). The MSIMI group, relative to the NLVR groups, demonstrated heightened mental stress-induced aggregation responses, as measured by area under the curve, to collagen 10 μM (6.95[5.54] vs. -14.23[8.75].; P = 0.045), epinephrine 10 μM (12.84[4.84] vs. -6.40[7.61].; P = 0.037) and to serotonin 10 μM plus ADP 1 μM (6.64[5.29] vs. -27.34[8.34]; P < .001). The resting platelet aggregation and serotonin transporter expression, however, were not different between the two groups. Conclusions These findings suggest that the dynamic change of platelet aggregation caused by mental stress may underlie MSIMI. While the importance of these findings requires additional investigation, they raise concern given the recognized relationship between mental stress-induced platelet hyperactivity and cardiovascular events in patients with IHD.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>25819856</pmid><doi>10.1016/j.ahj.2014.12.002</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Anxiety Atherosclerosis Blood platelets Blood pressure Cardiovascular Cardiovascular disease Citalopram - therapeutic use Collagen Drug therapy Electrocardiography Female Heart attacks Heart rate Humans Ischemia Laboratories Male Middle Aged Mortality Myocardial Ischemia - blood Myocardial Ischemia - etiology Platelet Aggregation - physiology ROC Curve Serotonin Serotonin Uptake Inhibitors - therapeutic use Stress Stress, Psychological - blood Stress, Psychological - complications Stress, Psychological - drug therapy Studies Treatment Outcome Variables |
| title | Platelet aggregation and mental stress induced myocardial ischemia: Results from the Responses of Myocardial Ischemia to Escitalopram Treatment (REMIT) study |
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