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

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

METHODS: We used latent class analysis (LCA) 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, SRS), with mental stress (summed stress score, SSS), and their difference (summed difference score, SDS), the latter being an index of inducible ischemia.

RESULTS: Mean age was 63 years (S.D. = 9 years), and 185 (28%) were women. LCA characterized the study sample into four distinct classes of incremental psychosocial distress. In women, class 4 (highest distress) had an adjusted 4.0-points higher SRS (95% CI: 0.2-7.7) as compared to class 1 (lowest distress), whereas no difference was observed in men (-0.87 points, 95%CI = -3.74-1.99), p=0.04 for interaction). There was no association between the psychosocial distress latent variable and SDS in either women or men.

CONCLUSION: Among CAD patients, 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 a with blunted hemodynamic response to mental stress in both men and women.