Mental Stress Test Research Articles

Dynamic myocardial perfusion computed tomography with mental stress test to detect changes in myocardial microcirculation in patients with anxiety and no obstructive coronary artery disease.

Mental stress can induce myocardial ischemia in patients with anxiety and other psychological disorders. Computed tomography myocardial perfusion imaging (CT-MPI) has the potential to quantitatively diagnose myocardial ischemia. The aim of this study was to measure changes in myocardial microcirculation perfusion (MMP) in patients with anxiety who have angina symptoms/ischemia but no obstructive coronary artery disease (INOCA) using dynamic CT-MPI in combination with a mental stress test. Patients with INOCA were divided into five subgroups (none, minimal, mild, moderate, and severe) according to the generalized anxiety disorder scale. Patients underwent dynamic CT-MPI with mental stress testing using a series of the standardized color word/arithmetic stressors. Myocardial blood flow (MBF) during resting and stress phases of CT-MPI was recorded. Fifty-eight patients with 986 segments were included for final analysis. Compared to patients with none, minimal, mild, and moderate anxiety, those with severe anxiety had the largest rate of MBF decrease and the largest MBF decrease value. At the same time, those with no anxiety had the largest rate of MBF increase, the largest MBF increase value (all p< 0.05). As anxiety intensified, the rate of MBF increased and the MBF value increased (r= -0.24, r= -0.27, p< 0.05). Concomitantly, the rate of MBF decreased and the MBF value decreased (r= 0.63, r= 0.43, p< 0.05). Dynamic CT-MPI with a mental stress test can be used to evaluate MMP in patients with anxiety and INOCA. Mental stress resulted in significant differences in changes in the rate and value of MBF among patients with different anxiety degrees. • Dynamic CT-MPI with mental stress test worked well to quantitatively evaluate myocardial microcirculation perfusion in patients with anxiety and INOCA. • The rates of MBF decrease and MBF decrease value were positively correlated with anxiety degree of anxiety patients with INOCA. • MBF change derived from CT-MPI with mental stress test had a good performance to predicting anxiety degree of patients with anxiety and INOCA.

Endothelial Dysfunction in Patients With Takotsubo Syndrome and its Role in Acute and Long Terms Of the Disease

Aim To evaluate the endothelial function using an Endo-PAT2000 instrument before and after mental stress tests in patients with Tacotsubo syndrome (TS) during acute and long-term periods and to compare the obtained results with laboratory markers of endothelial dysfunction (ED).Material and methods This study included 45 patients with TS (mean age, 63.5±13.7 years) and 40 healthy volunteers (control group, CG). All patients of the main group during the acute period (first 7-14 days) and long-term period (at 1 and 2 years), as well as CG subjects, underwent evaluation of the endothelial function with an Endo-PAT 2000 instrument, and the reactive hyperemia index (RHI) was determined before and after mental stress tests. Also, concentrations of endothelin 1 (ET-1) and numbers of circulating endothelial cells (CEC) were measured after a two-year follow-up of TS patients.Results During the acute period of disease, all TS patients (n=45) had ED: RHI was below the threshold level of 1.67; furthermore, 42 (93.3 %) patients retained a lower RHI following mental stress. At one year (n=40), 16 (40%) patients showed ED at rest along with a significantly increased mean RHI. Mental stress produced at one year was associated with ED in 28 (70 %) TS patients. At two years (n=44), resting RHI was lower than normal in 19 (43.2 %) patients. Mental stress tests performed at two years were associated with ED in 29 (65.9 %) patients (RHI ≤1.67). Only 10% of CG subjects had a lower-than-normal RHI, which was significantly less than in the main group of TS patients during the acute and long-term periods (p&lt;0.05). Mean values of laboratory markers for ED also were significantly different between TS patients during the long-term period of disease (n=41) and CG subjects (n=40; p&lt;0.01).Conclusion During acute and long-term periods of disease, most of TS patients had impaired vascular reactivity both at rest and during mental stress. The laboratory markers of ED, ET-1 and CEC can be used in clinical practice for evaluation of the risk for TS.

Physiological and Psychological Response to Acute Mental Stress in Female Patients Affected by Chronic Pulmonary Arterial Hypertension: An Explorative Controlled Pilot Trial.

Little is known about physiological and psychological responses to mental stress in stable patients affected by pulmonary arterial hypertension (PAH). The current explorative controlled pilot study was conducted to investigate whether heart rate (HR) and perceived stress would differ during standardized mental stress testing in PAH patients compared to healthy subjects. Correlation analysis between HR, perceived stress, participants' psychological status and performance on the mental stress task was also performed. The study included 13 female PAH patients (average age: 44.38 ± 10.88 years; average education: 14 ± 3.07 years; mean duration of illness: 9.15 ± 5.37 years) and 13 female controls similar in age (mean age: 47.85 ± 6.36 years) and education (15.92 ± 1.55 years). Participants performed a standardized 9 min mental stress test (computer based, adaptive math task). HR and perceived stress during the task were compared to resting baseline and correlated with psychological state and task performance. Both HR and perceived stress significantly increased during mental stress in a similar way in both groups. A significant correlation was found between HR and perceived stress. Our data show that moderate mental stress has a comparable effect on HR and perceived stress increase in stable PAH patients and control subjects.

Mental Stress-Induced Change in Plasma Stromal Cell-Derived Factor-1 and Adverse Cardiovascular Outcomes: A Cohort Study

BackgroundAcute psychological stress can provoke mental stress-induced myocardial ischemia (MSIMI) in coronary artery disease (CAD). Stromal cell-derived factor 1 (SDF1) is released in response to hypoxia, and higher levels of SDF1 are associated with adverse outcomes. We examined whether an increase in SDF1 level in response to mental stress predicts adverse outcomes in CAD patients. MethodsA total of 554 patients with stable CAD (mean age 63 years; 76% male; 26% Black) underwent standardized mental stress testing. Plasma SDF1 levels were measured at rest and 90 minutes after mental stress, and MSIMI was evaluated by 99mTc-sestamibi perfusion imaging. Participants were followed for 5 years for the primary endpoint of composite of death and myocardial infarction (MI) and the secondary endpoint of composite of death, MI, and heart failure hospitalization. Cox hazard models were used to assess the association between SDF1 change and incident adverse events. ResultsMean (standard deviation) SDF1 change with mental stress was +56.0 (230) pg/mL. During follow-up, a rise of 1 standard deviation in SDF1 with mental stress was associated with a 32% higher risk for the primary endpoint of death and MI (95% confidence interval, 6%-64%), independent of the resting SDF1 level, demographic and clinical risk factors, and presence of ischemia. A rise of 1 standard deviation in SDF1 was associated with a 33% (95% confidence interval, 11%-59%) increase in the risk for the secondary endpoint, independent of the resting SDF1 level, demographic, and clinical risk factors and presence of ischemia. ConclusionsAn increase in SDF1 level in response to mental stress is associated with a higher risk of adverse events in stable CAD, independent of MSIMI.

Hemodialysis Effects on Autonomic Function: Results of Linear and Nonlinear Analysis of Heart Rate Variability at Rest and in Response to Physical and Mental Stress Tests

Introduction: Cardiac arrhythmias are the most common cause of death in hemodialysis. Autonomic dysfunction plays a central role in this arrhythmogenic background. Previous studies on hemodialysis-related changes in heart rate variability (HRV) give contradictory results. This study investigated HRV indices both at rest and in response to physical and mental stimulation maneuvers at multiple time-points around and during the hemodialysis procedure. Methods: Autonomic function was assessed by linear and nonlinear HRV indices at predialysis, during dialysis (3 equal time-periods), postdialysis, and on the nondialysis day in 36 hemodialysis patients. Continuous measurement of beat-by-beat heart rate was recorded with Finometer-PRO (The Netherlands) at rest and after orthostatic, sit-to-stand, handgrip, and mental-arithmetic test. Results: The RMSSD, SD1, and SD2 indices significantly increased during dialysis (early-HD, mid-HD, late-HD periods) compared with the predialysis levels (p < 0.05) and returned to baseline postdialysis (RMSSD: 54.39 ± 83.73 vs. 137.98 ± 109.53* vs. 119.85 ± 97.34* vs. 144.47 ± 88.74* vs. 85.82 ± 121.43msec, *p < 0.05 vs. predialysis and postdialysis). No differences were detected in the above indices between the predialysis and nondialysis day. However, postdialysis, the HRV responses to orthostatic and sit-to-stand tests were more exaggerated than in the predialysis measurements (p < 0.05). The HRV responses both at resting and physical tests in the nondialysis day were similar to the predialysis levels. HRV indices in the mental arithmetic test during hemodialysis were much higher than at the nondialysis day (RMSSD: 77.05 [180.41] versus 19.75 [105.47] msec; p = 0.031). Conclusions: Hemodialysis causes marked changes in the autonomic function. Resting HRV indices return to baseline postdialysis, but HRV responses to physical stress remain exaggerated and return to baseline on the nondialysis day. Detecting patients with significant autonomic dysfunction may help towards reduction of arrhythmia risk through individualized approaches.

Abstract 13649: Differential Effect of Variable Autonomic Modulation Stimulation Parameters on Autonomic Function

Introduction: Reduced heart rate variability (HRV) is associated with increased risk of cardiovascular morbidity and mortality. Previous studies have shown that transcutaneous vagus nerve stimulation (tVNS) increases HRV and improves autonomic function, but the effect of variable stimulation parameters on autonomic function remains unclear. Hypothesis: We examined the effect of variable stimulation parameters of tVNS on autonomic function. Methods: Healthy volunteers were recruited for this study. Each participant underwent autonomic function testing consisting of HRV during deep breathing and mental arithmetic stress test (MAST), with and without tVNS. Participants were randomized to 4 groups of different stimulation parameters in a 2x2 fashion (frequency 5Hz and 20Hz; amplitude 1mA below discomfort threshold or 50% below discomfort threshold). tVNS was applied for 5 minutes for each session. HRV was analyzed in a blinded fashion using Kubios software. Results were compared with 2-way ANOVA, adjusted for multiple comparisons. Results: Thirty participants were included (mean age 39±14 years, 70% female). Stimulation amplitude was 26±13 mA and 14±7 mA in the 1mA below and 50% below discomfort threshold groups (p=0.001). There was a greater change in HRV parameters with 20Hz vs. 5Hz stimulation versus baseline during MAST (low frequency: -8.1±2.8%, vs. 1.4±1.8%, p=0.01; high frequency 8.2±3.7% vs. -1.3±1.8%, p=0.03; SD2 of Poincare plot -7.9±2.9 ms vs. 4.2±3.1 ms, p=0.005, respectively; Figure). No differences were observed between the 2 different amplitude groups. Conclusions: Stimulation frequency may influence the acute effect of autonomic modulation on autonomic function parameters. These findings have implications for autonomic modulation study design. Further studies in disease states are warranted.

Characteristics and prognosis of the catecholamine induced QT prolongation syndrome

Abstract Background We have recently demonstrated association of unexplained sudden cardiac arrest (SCA) with inheritance of catecholamine induced QT prolongation (CIQTP). Objective We here aim to describe incidence, characteristics and prognosis of this new syndrome in young patients with unexplained SCA or their relatives. Methods We reviewed the medical screening of all consecutive patients or their first-degree relatives explore from 2015 after the occurrence of a SCA before age 45. Structural heart disease or inherited arrhythmia diseases were excluded. A mental stress test was performed, as previously described, for each family members. All families with a positive mental stress were included in the study. Genetic screening was performed in at least one positive patient per family using targeted sequencing on a panel of 109 genes associated with inherited arrhythmias and cardiomyopathies. Results Among 456 patients screened (24 after SCA, 432 for familial screening) of 153 families, we identified 10 families (6.5%) with a catecholamine induced QT prolongation. No mutation was identified in these families. One hundred and ten patients were screened in CIQTP families. Thirty-four patients (30.9%) presented a CIQTP (mean age 42±20 yo, 64.7% of women). Five (14.7%) patients presented with previous symptoms (including 4 syncope and 1 SCA). Two patients (5.9%) were implanted with an ICD and eleven (32.3%) were treated with beta blocker therapy mainly because of QT prolongation &amp;gt;500 ms after mental stress test or previous symptoms. After a 3.6±1.8 years of follow up, no sudden cardiac death nor syncope occurred on beta blocker therapy except for one patient implanted with an ICD after a SCA. Under beta blocker treatment the patient was asymptomatic for 5 years. After a suddenly stop of the beta blocker treatment, the patient underwent VF. For 3 years now the patient is asymptomatic under beta blocker treatment. Conclusions In our experience, CIQTP families represent 6.5% of cases of unexplained SCD and suggest systematic screening with a mental stress test for family screening after the occurrence of a SCA. Beta blocker therapy is very efficient to reduce the risk of SCA. Funding Acknowledgement Type of funding sources: None.

Association between quality of life and mental stress-induced myocardial ischaemia in high-risk patients after coronary revascularization

ObjectiveWe sought to determine the association between mental stress-induced myocardial ischaemia (MSIMI) and quality of life (QoL) in patients with coronary artery disease (CAD) after coronary revascularization.MethodsThis cohort study involved patients with high-risk MSIMI who received coronary revascularization between Dec 2018 and Dec 2019. Patients who screened positive for depression/anxiety were enrolled in this study. Mental stress was induced by the Stroop Colour and Word Test 1 month after coronary revascularization. All participants underwent single photon emission computed tomography (SPECT) scans at rest and under mental stress. MSIMI was defined as the presence of four abnormal SPECT phenomena. QoL was assessed using the Seattle Angina Questionnaire (SAQ) prior to treatment and 1 month after coronary revascularization.ResultsOf the 1845 consecutive patients who received coronary revascularization, 590 (31.9%) had depression/anxiety, and 205 agreed to accept the mental stress test. During the average observation period of 33 days, 105 (51.2%) patients exhibited MSIMI. All SAQ subscales showed significant improvement, except for QoL, in the MSIMI group. The QoL score was lower (− 0.2 ± 32.7 vs. 13.1 ± 29.9, P = 0.005), and the proportion of deterioration in QoL was higher (50.5% vs. 31.9%, P = 0.010) in the MSIMI group than in the non-MSIMI group. Those with a deterioration in QoL had approximately twice the rate of MSIMI than those with an improvement in QoL (unadjusted OR: 2.019, 95% CI 1.122–3.634, P = 0.026; adjusted OR: 1.968, 95% CI 1.083–3.578, P = 0.017).ConclusionAmong patients with CAD who received coronary revascularization and had depression/anxiety, deterioration in QoL increased the likelihood of MSIMI. Hence, our results indicate that deterioration in QoL is a predictor of MSIMI.Trail Registration ChiCTR2200055792, retrospectively registered, 2022.1.20, www.medresman.org.cn

Mitigating Initial Orthostatic Hypotension: Mechanistic Roles of Muscle Contraction Versus Sympathetic Activation.

Initial orthostatic hypotension (IOH) is defined by a large drop in blood pressure (BP) within 15 s of standing. IOH often presents during an active stand, but not with a passive tilt, suggesting that a muscle activation reflex involving lower body muscles plays an important role. To our knowledge, there is no literature exploring how sympathetic activation affects IOH. We hypothesized involuntary muscle contractions before standing would significantly reduce the drop in BP seen in IOH while increasing sympathetic activity would not. Study participants performed 4 sit-to-stand maneuvers including a mental stress test (serial 7 mental arithmetic stress test), cold pressor test, electrical stimulation, and no intervention. Continuous heart rate and beat-to-beat BP were measured. Cardiac output and systemic vascular resistance were estimated from these waveforms. Data are presented as mean±SD. A total of 23 female IOH participants (31±8 years) completed the study. The drops in systolic BP following the serial 7 mental arithmetic stress test (-26±12 mm Hg; P=0.004), cold pressor test (-20±15 mm Hg; P<0.001), and electrical stimulation (-28±12 mm Hg; P=0.01) were significantly reduced compared with no intervention (-34±11 mm Hg). The drops in systemic vascular resistance following the serial 7 mental arithmetic stress test (-391±206 dyne×s/cm5; P=0.006) and cold pressor test (-386±179 dyne×s/cm5; P=0.011) were significantly reduced compared with no intervention (-488±173 dyne×s/cm5). Cardiac output was significantly increased upon standing (7±2 L/min) compared with during the sit (6±1 L/min; P<0.001) for electrical stimulation. Sympathetic activation mitigates the BP response in IOH, while involuntary muscle contraction mitigates the BP response and reduces symptoms. Active muscle contractions may induce both of these mechanisms of action in their pretreatment of IOH. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03970551.

Association of Mental Stress–Induced Myocardial Ischemia With Cardiovascular Events in Patients With Coronary Heart Disease

Mental stress-induced myocardial ischemia is a recognized phenomenon in patients with coronary heart disease (CHD), but its clinical significance in the contemporary clinical era has not been investigated. To compare the association of mental stress-induced or conventional stress-induced ischemia with adverse cardiovascular events in patients with CHD. Pooled analysis of 2 prospective cohort studies of patients with stable CHD from a university-based hospital network in Atlanta, Georgia: the Mental Stress Ischemia Prognosis Study (MIPS) and the Myocardial Infarction and Mental Stress Study 2 (MIMS2). Participants were enrolled between June 2011 and March 2016 (last follow-up, February 2020). Provocation of myocardial ischemia with a standardized mental stress test (public speaking task) and with a conventional (exercise or pharmacological) stress test, using single-photon emission computed tomography. The primary outcome was a composite of cardiovascular death or first or recurrent nonfatal myocardial infarction. The secondary end point additionally included hospitalizations for heart failure. Of the 918 patients in the total sample pool (mean age, 60 years; 34% women), 618 participated in MIPS and 300 in MIMS2. Of those, 147 patients (16%) had mental stress-induced ischemia, 281 (31%) conventional stress ischemia, and 96 (10%) had both. Over a 5-year median follow-up, the primary end point occurred in 156 participants. The pooled event rate was 6.9 per 100 patient-years among patients with and 2.6 per 100 patient-years among patients without mental stress-induced ischemia. The multivariable adjusted hazard ratio (HR) for patients with vs those without mental stress-induced ischemia was 2.5 (95% CI, 1.8-3.5). Compared with patients with no ischemia (event rate, 2.3 per 100 patient-years), patients with mental stress-induced ischemia alone had a significantly increased risk (event rate, 4.8 per 100 patient-years; HR, 2.0; 95% CI, 1.1-3.7) as did patients with both mental stress ischemia and conventional stress ischemia (event rate, 8.1 per 100 patient-years; HR, 3.8; 95% CI, 2.6-5.6). Patients with conventional stress ischemia alone did not have a significantly increased risk (event rate, 3.1 per 100 patient-years; HR, 1.4; 95% CI, 0.9-2.1). Patients with both mental stress ischemia and conventional stress ischemia had an elevated risk compared with patients with conventional stress ischemia alone (HR, 2.7; 95% CI, 1.7-4.3). The secondary end point occurred in 319 participants. The event rate was 12.6 per 100 patient-years for patients with and 5.6 per 100 patient-years for patients without mental stress-induced ischemia (adjusted HR, 2.0; 95% CI, 1.5-2.5). Among patients with stable coronary heart disease, the presence of mental stress-induced ischemia, compared with no mental stress-induced ischemia, was significantly associated with an increased risk of cardiovascular death or nonfatal myocardial infarction. Although these findings may provide insights into mechanisms of myocardial ischemia, further research is needed to assess whether testing for mental stress-induced ischemia has clinical value.

Effect of Laboratory Mental Stressors on Cardiovascular Reactivity in Young Women During Different Phases of Menstrual Cycle: An Observational Study.

Introduction: Excessive cardiovascular reactivity to mental stress may be a risk factor for cardiovascular disease. However, there is inconsistent report in the literature regarding change in cardiac autonomic tone with the phase of the menstrual cycle and how it is affected by mental stress. Therefore, the present study was aimed at determining the cardiovascular reactivity to different laboratory mental stressors during follicular and luteal phase of menstrual cycle using heart rate variability (HRV).Methods: Thirty-three regularly cycling young females (19–35 years of age) were exposed to four cognitive tasks (Stroop test, Mental Rotation test, n-back test, and Mental Arithmetic Stress Test [MAST]) employed as laboratory mental stressors. HRV of the study participants were recorded before, during, and after each cognitive task and the recording was done in both phases of menstrual cycle for each individual.Results: A significant difference was observed in time domain parameters and nonlinear parameters of HRV in pretest versus during-test condition and during-test versus post-test conditions, but not in frequency domain parameters. No phase difference was found in time domain or frequency domain analysis of HRV in baseline or during performance of task. MAST performance (score out of 50) was significantly higher in luteal than follicular phase, while other tests showed no such difference.Conclusion: All four mental stress tasks used in the present study were able to elicit significant decrease in parasympathetic tone during performance of task as compared with baseline values of HRV. The present study did not elicit any phase difference in cardiovascular reactivity.

Influence of mental stress on intraocular pressure and visual field testing: is there a white coat syndrome in glaucoma?

To investigate the effects of mental stress stimulus on intraocular pressure (IOP) measurement and visual field (VF) testing. Patients with open angle glaucoma underwent a baseline IOP measurement and VF testing. Afterwards, they completed a computerized mental stress test (Stroop test) which is a known standardized method to induce mental stress. After test completion, patients underwent a second IOP measurement and VF testing. Seventy-two eyes of 36 patients were enrolled. Mean age was 67.0 ± 9.5years (range 47-84years). The mean baseline IOP was 15.0mmHg, and after the Stroop mental stress test, IOP increased to 16.0mm Hg (P < 0.001). There was a trend towards significant mean deviation decreased from -6.9 dB to -8.0 dB (P = 0.054, t-test) following the stress test. This difference becamesignificant using the Wilcoxon nonparametric test (P = 0.008).Correlation was found between glaucoma severity and change in IOP (P = 0.02) and PSD (P < 0.01). We found a small but statistically significant increase in IOP and a trend towards deterioration of visual field mean deviation, following a short mental stress test. Patients with more severe glaucoma showed more pronounced changes. Our results suggest that mental stress could affect IOP measurement in the clinic.

Evaluation of Autonomic Function in Polycystic Ovary Syndrome with Hypothyroidism

Background and Aim: Polycystic ovary syndrome (PCOS) and thyroid disorders are commonest endocrine disorders; both of these disorders have profound effect on reproductive function in women’s. An increase in ovarian volume and cystic changes in ovaries have been reported in hypothyroidism. Recent studies reveal that PCOS might be associated with cardiovascular autonomic dysfunction and the thyroid hormone also influences the autonomic nervous system. So the aim of the study was to first, evaluate and compare autonomic function in PCOS as well as in PCOS with hypothyroidism, second, correlation between thyroid stimulating hormone (TSH) and autonomic function tests (AFT) in both the groups and third, study also provided further exploration in autonomic function in PCOS in presence of hypothyroidism. Methods: Total 43 newly diagnosed not on medications subjects were recruited, these subjects were divided into group A PCOS (n=33) and group B PCOS with hypothyroidism (n=10). Anthropometric measurements were taken from all the participants and autonomic function tests for assessing parasympathetic function (such as heart rate response to immediate standing and standing to lying ratio) and sympathetic function (such as blood pressure response to immediate standing and mental arithmetic stress test) were employed, then measurements was taken according to the respective scoring procedures. Results: In our studied population PCOS as well as PCOS with hypothyroidism showed autonomic dysfunction but no significant difference was found between them. No correlation and significance was found between TSH and AFT in both the groups. Conclusion: Our study concluded that the presence of hypothyroidism did not further affect autonomic function in PCOS and TSH was unrelated to AFT.

Effect of Online Classes on Physical and Mental Well-Being of Students During Covid-19

Context: The coronavirus has shut down all schools and universities over the globe. With idiosyncratic upsurge of online learning, nowadays, teaching is undertaken remotely on digital platforms by the use of laptops and mobile phones. Many researches have shown that the excessive or prolonged use of screens can impact mental and physical health. The mental and physical affections include stress, depression, sleep disorders, impact on eyesight, postural pain, hand disabilities, and musculoskeletal disorders. Aims: The aim of this study is to analyze the effect of online classes on the mental and physical well-being of students due to the COVID-19 pandemic. Settings and Design: The survey was conducted on an online mode through Google forms. All gender college-going students within the age group of 18–25 years undergoing online classes for a minimum of 1 month were included in the study. Subjects and Methods: The assessment of mental health was done using the Perceived Mental Stress Test Scale (Psychological Stress Test) and the Patient Health Questionnaire, whereas for the assessment of the physical health, the Neck disability index, and the Oswestry low back pain disability index was used. Statistical Analysis Used: Karl Pearson's correlation coefficient was applied to find the correlation between the duration of online classes and stress, depression, neck, and back disability. Results: A significant effect of online classes was found on the mental and physical health of students, 57.3% of population had moderate stress, 32% of population had mild depression, 48% of population had mild neck pain, and 41.3% of population moderate back pain. Conclusion: Students' mental and physical health has been affected as a result of longer duration spent online on laptops and phones for classes.

Abstract 014: Posttraumatic Stress Disorder, Mental Stress-induced Myocardial Ischemia And Cardiovascular Outcomes In Patients With CAD

Introduction: Mental stress-induced myocardial ischemia (MSI) is a risk marker for adverse outcomes among coronary artery disease (CAD) that is more prevalent among patients with posttraumatic stress disorder (PTSD). Hypothesis: CAD patients with PTSD who develop MSI experience a higher risk of adverse cardiovascular events compared with those who do not develop MSI. Methods: We studied 995 individuals with stable CAD who participated in two contemporary cohort studies with similar protocols, the Mental Stress Ischemia Prognosis Study (MIPS), and the Myocardial Infarction and Mental Stress Study (MIMS). Provocation of myocardial ischemia with a standardized mental stress test (speech task) was assessed with single-photon emission computed tomography. PTSD was assessed with the structured clinical interviews for DSM-IV. Participants were categorized into four groups based on their MSI and PTSD status. The primary endpoint was a composite outcome of cardiovascular death or nonfatal myocardial infarction (MI), stroke, or heart failure hospitalization. Cox regression models were used to investigate the interaction of PTSD and MSI on the study endpoint in the two samples pooled with meta-analysis. Results: In total, 603 participants in MIPS and 392 in MIMS were included. MSI occurred in 16% of the patients in MIPS and 17% in MIMS. Over a 5-year median follow-up, there were 126 outcome events in MIPS and 117 in MIMS. In Cox regression models with adjustment for demographic and clinical risk factors, participants with both MSI and PTSD had a higher risk for the study endpoint, compared to those with neither. In contrast, participants with PTSD or MSI but not both were not at a higher risk ( p interaction=0.01). Separate analyses in the two studies were consistent. Conclusions: There is a synergistic association of PTSD and MSI on adverse outcomes in CAD patients. These findings support the confluence of chronic mental health vulnerability with acute stress responses in defining elevated risk in CAD patients.patients.

Abstract MP10: A Novel Genetic Locus Influences Microvascular Reactivity To Acute Psychological Stress

Background: Excessive peripheral microvascular constriction during acute psychological stress, measured using peripheral arterial tonometry reflects similar changes in coronary blood flow.The ratio of digital pulse wave amplitude during stress compared to rest (sPAT) is used to estimate the degree of microvascular response to stress. Hypothesis: We hypothesized that genetic factors contribute to the degree of microvascular constriction during mental stress and that excessive vasoconstriction is associated with adverse cardiovascular outcomes. Methods: A total of 580 stable CAD subjects of European and African ancestries from two prospective cohort studies underwent mental stress testing with a standardized public speaking stressor. Digital pulse wave amplitude was continuously measured using PAT and the stress/rest PAT ratio (sPAT) of pulse wave amplitude during mental stress/baseline was calculated. Genotyping was performed using Illumina’s Multi-Ethnic Genotyping Array platform and imputed to the 1000 Genome reference panel. Ethnicity-specific genome-wide association studies (GWAS) of sPAT were conducted using linear regression of additive genetic mode adjusted for age, sex and population stratification in both cohorts. A trans-ethnic meta-analysis integrated the GWAS results from four sub-cohorts. Upon 5-year follow-up, Fine and Gray’s sub-distribution hazard ratios (sHR) were used to examine the association between sPAT ratio (&gt; vs=&lt; median) and the composite endpoint of cardiovascular death, myocardial infarction, revascularization, and hospitalization for heart failure. Results: Mean age was 63±9; 65% male, 35% African American. We identified three SNPs in linkage disequilibrium on chr7:111,666,943 T&gt;C (rs6466396); chr7: 111,668,622 T&gt;G (rs876170); chr7: 111,668,623 T&gt;G (rs876169) that were associated with greater sPAT ratio by means of 0.13, 0.12 and 0.10, ( P = 1.42E-08). The sPAT-associated locus was within DOCK4 gene which encodes Dedicator of Cytokinesis 4, an essential protein for angiogenesis and brain development, and a known locus for obesity. After adjusting for demographic and cardiovascular risk factors, medications, and rate-pressure product change during mental stress, those with low sPAT ratio were at significantly higher risk of adverse outcomes (sHR 1.8 [95% CI 1.1 - 2.8]). Conclusion: We have identified a genetic basis for stress-induced vasomotion. Presence of allele C (rs6466396) is associated with increased vasoconstriction during mental stress, and thus may predispose CAD patients to a higher risk for adverse cardiovascular outcomes with stressful exposure.

Multiomics, virtual reality and artificial intelligence in heart failure.

Aim: Multiomics delivers more biological insight than targeted investigations. We applied multiomics to patients with heart failure (HF) andreduced ejection fraction (HFrEF), with machine learning applied to advanced ECG (AECG) and echocardiography artificial intelligence (Echo AI). Patients & methods: In total, 46patients with HFrEF and 20 controls underwent metabolomic profiling, including liquid/gas chromatography-mass spectrometryand solid-phase microextractionvolatilomics in plasma and urine. HFrEF was defined using left ventricular (LV)global longitudinal strain, EF and N-terminal pro hormone BNP. AECG and Echo AI were performed over 5min, with a subset of patients undergoing a virtual reality mental stress test. Results: A-ECG had similar diagnostic accuracy as N-terminal pro hormone BNP for HFrEF (area under the curve =0.95, 95% CI: 0.85-0.99), and correlated with global longitudinal strain (r=-0.77, p<0.0001), while Echo AI-generated measurements correlated well with manually measured LVend diastolic volumer=0.77, LVend systolic volume r=0.8, LVEF r=0.71, indexed left atriumvolume r=0.71 and indexed LV mass r=0.6, p<0.005. AI-LVEF and other HFrEF biomarkers had a similar discrimination for HFrEF (area under the curve AI-LVEF =0.88;95% CI: -0.03 to0.15;p=0.19). Virtual reality mental stress test elicited arrhythmic biomarkers on AECG and indicated blunted autonomic responsiveness (alpha2 of RR interval variability, p=1×10-4) in HFrEF. Conclusion: Multiomics-related machine learning shows promise for the assessment of HF.

Detection of Cognitive Impairment by Choice Auditory Reaction Time (ART) and Visual Reaction Time (VRT)s during Acute Mental Stress in Young Hypertensives: A Case Control Study.

Acute stress is known to be associated with both negative and positive influences on cognitive performance. Hypertension is one of the risk factors for lowered cognitive performance. Mental stress testing is easier to administer and can be regulated by the investigator. Mental arithmetic using serial subtraction is the most widely used method to administer stress. Reaction time (RT) is widely used to assess cognitive domains like attention, execution and psychomotor speed. Researchers have shown choice reaction times are delayed in hypertension. It is not known whether acute mental stress improves or deteriorates attention, execution and psychomotor speed in hypertension. We hypothesized in the present study that acute mental stress deteriorates cognitive function in hypertensives without overt cerebrovascular disease or other vascular risk factors. After getting medical ethical clearance from our institution, this case-control study was carried out over eight months (January 2017 to September 2017). 60 subjects between the age group of 35 to 55 years were included in the study. They were divided into 2 groups. Group 1 consisted of 30 diagnosed cases of hypertension at least two years of duration. Group 2 consisted of 30 sex and age-matched controls. MMSE was performed to assess the cognitive function in these groups. Simple (S) and choice (C) auditory reaction time (ART) and visual reaction time (VRT)s were measured at rest and acute mental stress in these groups to assess cognitive function. Predictive value of VRTC resting and VRTC during acute mental stress among hypertensives for cognitive dysfunction was calculated using the receiver operating characteristic (ROC) curve. There was significant difference ART and VRT, both simple and choice, in hypertensive and nonhypertensive subjects and these reaction times further increased during mental stress (P<0.001). VRTC can be a predictor of cognitive dysfunction in hypertensives and during acute mental stress. A significant difference in cognitive functions in hypertensive and nonhypertensive subjects exists and this further deteriorates with acute mental stress.

ESTIMATION OF MEAN ARTERIAL PRESSURE BY THE ANALYSIS OF BRACHIAL PULSE WAVEFORM RECORDED BY APPLANATION TONOMETRY AND COMPARISON WITH CURRENTLY USED ALGORITHMS

Objective: Mean arterial pressure (MAP) is usually calculated by adding one third of pulse pressure (PP) to diastolic blood pressure (DBP). This formula assumes that the average waveform of pulse pressure (PP) is constant in all individuals and 33.3% of PP is needed to obtain MAP (MAP = DBP + PPx0.333). Other empirical formulas were proposed to calculate MAP, by adding to DBP a different established percentage of PP: MAP = DBP + PPx0.40; MAP = DBP + PPx0.412; MAP = DBP + PPx0.333 + 5mmHg. The estimation of MAP by considering a fixed relationship between SBP and DBP may not be appropriate in the single patient, if significant inter-individual and intra-individual variations occur in the pressure waveform. Design and method: We evaluated the inter-individual variations in MAP calculated from the integral of brachial pressure waveform recorded by applanation tonometry in 1526 patients belonging to 3 distinct cohorts: elderly, hypertensive, and normotensive adults, and the intra-individual variations in 19 healthy controls after a mental stress test. Results: The percentage of PP required to be added to DBP to obtain MAP was extremely variable among individuals, ranging from 23% to 58% (mean: 42.2 ± 5.5%), was higher in females (42.9 ± 5.6%) compared to males (41.2 ± 5.1%, p &lt; 0.001), lower in the elderly cohort (40.9 ± 5.3%) than in the general population cohort (42.8 ± 6.0%, p &lt; 0.001) and in the hypertensives (42.4 ± 4.8%, p &lt; 0.001). This percentage was significantly associated with DBP (b = 0.357, p &lt; 0.001) and gender (b = 0.203, p &lt; 0.001). A significant increase in this percentage (from 39.9 ± 3.2 to 43.0 ± 4.0, p &lt; 0.0001) was found in 19 volunteers, after mental stress test, and was significantly correlated to the increase in blood pressure and heart rate (p = 0.001). MAP value assessed on the brachial tonometric curve was compared with the MAP estimated by formulas proposed in the literature: the average bias from tonometric MAP (mean ± 1.96xSD) was: -5.0 ± 6.7 mmHg when MAP = DBP + PPx0,333; -1.2 ± 6.1 mmHg when MAP = DBP + PPx0.40; -0.6 ± 6.1 mmHg when MAP = DBP + PPx0.412; -0.4 ± 6.7 mmHg when MAP = DBP + PPx0.333 + 5. Conclusions: Due to high interpersonal variability, the estimation of MAP based on fixed formulas is unreliable and inadequate. An improvement in the evaluation of MAP is advisable in daily clinical practice and may be based on the analysis of brachial pulse waveform.

Cardiovascular Autonomic Modulation during Metronomic Breathing and Stress Exposure in Patients with Borderline Personality Disorder

Introduction: Given the growing evidence of reduced heart rate variability in psychiatric diseases associated with emotional instability, we investigated cardiovascular autonomic modulation in patients with borderline personality disorder (BPD) during resting state, parasympathetic stimulation (metronomic breathing), and sympathetic stimulation (mental arithmetic stress test). Methods: In 29 BPD outpatients and 30 controls, we recorded RR-intervals (RRI), blood pressure, skin conductance levels, and respiratory frequency during resting state, metronomic breathing, stress anticipation, stress exposure, and stress recovery. We calculated baroreflex sensitivity (BRS) and parameters of heart rate variability, including the root mean square of successive differences (RMSSD), an index of cardiovagal modulation. Results: During resting state, BPD patients showed higher blood pressure and shorter RRI, as well as lower RMSSD and BRS than controls. Metronomic breathing increased RMSSD and BRS in BPD patients. During the stress exposure, BRS significantly decreased in controls, but not in BPD patients. Furthermore, BPD patients showed less cardioacceleration in response to stress exposure than controls. During stress recovery, we found increases in RMSSD and BRS in controls, but not in BPD patients. Conclusion: Our data show reduced cardiovascular autonomic modulation in BPD patients during resting state, psychophysiological relaxation, and stress exposure. The results indicate a vagal modulation deficit in this cohort. Breathing techniques, such as metronomic breathing, might be helpful to reduce stress and to increase vagal tone in BPD patients.