Brain Activation during Acute Mental Stress and Outcomes in Patients with Coronary Artery Disease Open Access
Moazzami, Kasra (Spring 2021)
Abstract
Psychological stress is a risk factor for angina and major adverse cardiovascular events (MACE) in individuals with coronary artery disease (CAD). Certain brain regions that control both emotional states and cardiac physiology may be involved in this relationship. The inferior frontal lobe and the rostromedial prefrontal cortex (rmPFC) are two important brain regions that processes stress and regulates immune and autonomic functions. However, it is unclear if activation of these regions with stress correlate with angina or MACE in individuals with CAD. Individuals with stable CAD underwent acute mental stress testing using a series of standardized speech/arithmetic stressors in conjunction with high resolution positron emission tomography imaging of the brain. Blood flow to the inferior frontal lobe and rmPFC were evaluated as a ratio compared to whole brain flow for each scan. Interleukin-6 (IL-6) levels 90 minutes post-stress, and high-frequency heart rate variability (HF-HRV) during stress were also assessed. We analyzed 148 individuals with CAD (mean age (SD) 62 (8) years; 69% male, and 35.8% African American). For every doubling in the inferior frontal lobe activation, angina frequency was increased by 13.7 units at baseline (β̂ 13.7, 95% CI 6.3, 21.7, p=0.008) and 11.6 units during follow up (β̂ 11.6, 95% CI 4.1, 19.2, p=0.01) in a model adjusted for baseline demographics. . After adjustment for baseline demographics, risk factors, and baseline levels of IL-6 and HF-HRV, higher rmPFC stress reactivity was independently associated with higher IL-6 and lower HF-HRV with stress. During a median follow-up of 3 years, 34 subjects (21.3%) experienced a MACE. Each 1SD increase in rmPFC activation with mental stress was associated with a 21% increase risk of MACE (HR 1.21, 95% CI 1.08-1.37). Stress-induced IL-6 and HF-HRV explained
15.5% and 32.5% of the relationship between rmPFC reactivity and MACE. In conclusion, Inferior frontal lobe activation with mental stress is independently associated with angina at baseline and during follow-up. Also, greater rmPFC stress reactivity is associated with incident MACE and is at least partly mediated by immune and autonomic responses to mental stress.
Table of Contents
Introduction
1
Background
2
Methods
4
Results
12
Discussions
17
References
22
Tables
27
Figures
35
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