情绪压抑和精神紧张引起的心肌缺血—一个无形的杀手（英文课件）PPT.ppt

From 1989 to 1993, we performed a series of mental stress tasks among 136 patients with documented CAD and a recent positive stress test to investigate certain characteristics of the mental stress induced ischemia. In this study, we learned that mental stress testing is more likely to cause LVEF reduction, i.e., a global dysfunction resulting in decreased cardiac output, than segmental wall ischemia (indicated by WMA and ECG changes) which more likely to be caused by exercise test. However, overall, the rate of ischemia is about the same between those two testing modalities. We therefore conducted a study to exam the relationship of depression and mental stress induced myocardial ischemia. This is the plot of regression data indicating the probability of WMA in relationship of depressive symptoms. Yellow solid line represents the estimated poit, and green/red dash lines for the 95% CI. Apparently, the relationship is not linear. It is curvilinear. To capture the curvilinear, we used the technique of the restricted cubic splines, which allows the regression slop to bind at a certain inflection point along the range of the predictor variable. In this case, the ultimate implication of this technique is that separate regression slopes are estimated for patients with CESD score = 19 and for ones CESD score 19. Results here suggest that, high level of depressive symptoms measured by CES-D, up to 19, is significantly associated with increased likelihood of mental stress-induced ischemia. To be specific, for every 5 points increasing up to 19, a chance of a patient with stable CAD experience mental stress induced ischemia by at least one of the 5 tasks used is 2.8 times higher than patients whose depression measurement below that level. On the other hand, every 5 points increase above 19 is associated with a reduced likelihood of having ischemia during mental stress testing. Pathophysiological model of the relationships between chronic, episodic, and acute