Cardiovascular and Circulatory Responses to Acute Mental Stress Among Individuals with Ischemic Cardiomyopathy.

OBJECTIVE: We studied responses to acute mental stress in individuals with stable coronary artery disease (CAD) with and without heart failure with reduced ejection fraction (HFrEF). METHODS: Individuals with stable CAD ( N = 313, 45 with HFrEF) underwent a laboratory-based mental stress. HFrEF was defined as an ejection fraction of <40%. Hemodynamic reactivity and vasoconstriction during mental stress were evaluated using changes in systolic blood pressure and peripheral arterial tonometry, respectively. Immune function was assessed by measuring changes in interleukin-6 (IL-6) and circulating progenitor cell counts enumerated using flow cytometry of CD34-expressing mononuclear cells before and 90 minutes after mental stress. RESULTS: During the mental stress testing, patients in the HFrEF exhibited a smaller (blunted) increase in systolic blood pressure compared with the non HFrEF group (30.4 ± 14.1 vs 41.9 ± 16.1 mm Hg, p < .001), greater vasoconstriction (PAT ratio 0.69 ± 0.30 vs 0.83 ± 0.40, p = .02), a larger increase in IL-6 levels (0.91 ± 0.11 vs 0.42 ± 0.14 pg/mL, p = .01), and larger increases in circulating progenitor cell counts (0.68 ± 0.12 vs 0.22 ± 0.11 cell/L, p = .009). After adjustment for demographic and traditional risk factors, each of these 4 maladaptive stress responses remained independently associated with the presence of HFrEF. CONCLUSIONS: Among individuals with stable CAD, the presence of HFrEF was independently associated with a blunted systolic blood pressure response, greater vasoconstriction, increased inflammation, and enhanced progenitor cell mobilization with mental stress, a response that is associated with adverse long-term outcomes.