精神压力下冠状动脉血管功能障碍女性的副交感神经反应与非心源性胸痛和对照比较

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature Pub Date : 2025-05-16 DOI:10.1016/j.ijcha.2025.101673

Puja K. Mehta , Shafa-at A. Sheikh , Esha K. Dave , Rahim K. Shakoor , Tina Torbati , Amit Shah , Marc D. Thames , Liu Qiang , Yi-An Ko , Janet Wei , Chrisandra Shufelt , Michael D. Nelson , Bruce Samuels , Babak Azarbal , Jeanie Park , Michael R. Irwin , David S. Krantz , C. Noel Bairey Merz

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引用次数: 0

摘要

背景冠状动脉血管功能障碍（CVaD）有助于缺血，即使在没有阻塞性冠状动脉疾病。我们假设，与非心源性胸痛（NCCP）和对照（RC）组相比，对精神应激的异常自主神经反应是CVaD的关键病理生理机制。方法在心脏自主神经系统研究中对70例女性（经冠状动脉功能检查诊断为CVaD的35例，经NCCP诊断的19例，经RC诊断的16例）进行心理压力测试（算术和愤怒回忆）。RC组无症状，无危险因素，运动平板试验正常。频率域心率变异性（HRV, ms2）在基线和精神压力时获得，高频功率作为公认的副交感神经测量。低频/高频比值可能反映交感优势。采用方差分析进行比较。结果scvad组较NCCP组年龄大（57.1±9.6∶50.4±11.3岁，p = 0.025），与RC组年龄相近（54.6±14.5岁，p = 0.45）。各组HRV在基线时相似。在愤怒回忆时，CVaD组的HF HRV低于NCCP组（分别为5.03±1.05 vs 6.00±1.17,p = 0.006），但低于RC组（5.74±1.02,p = 0.077）。计算时，CVaD组HF HRV低于NCCP组（5.06±1.12 vs 6.00±1.17,p = 0.007）和RC组（6.04±0.83,p = 0.01）。三组间LF/HF比值无显著差异。结论与NCCP和RC女性相比，CVaD女性表现出更大的压力诱导迷走神经戒断。进一步研究改变的自主神经反应作为CVaD的机制是必要的。

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Parasympathetic response in women with coronary vascular dysfunction during mental stress compared to those with non-cardiac chest pain and reference controls

Background

Coronary vascular dysfunction (CVaD) contributes to ischemia even in the absence of obstructive coronary artery disease. We hypothesize that abnormal autonomic reactivity to mental stress is a key pathophysiologic mechanism in CVaD compared to non-cardiac chest pain (NCCP) and reference control (RC) groups.

Methods

Seventy women (35 with CVaD diagnosed by coronary function testing, 19 with NCCP, and 16 RC) underwent mental stress testing (arithmetic and anger recall) in the Cardiac Autonomic Nervous System study. RC group was asymptomatic with no risk factors and normal exercise treadmill testing. Frequency domain heart rate variability (HRV, ms²) was obtained at baseline and during mental stress, with high frequency (HF) power as an accepted parasympathetic measure. Low frequency (LF)/HF ratio may reflect sympathetic dominance. ANOVA was used for comparisons.

Results

CVaD group was older compared to NCCP (57.1 ± 9.6 vs. 50.4 ± 11.3 years, p = 0.025, respectively), but age-matched to RC group (54.6 ± 14.5, p = 0.45). HRV was similar at baseline among the groups. During anger recall, CVaD group had lower HF HRV vs. NCCP (5.03 ± 1.05 vs 6.00 ± 1.17, p = 0.006, respectively), but not vs. RC (5.74 ± 1.02, p = 0.077). During arithmetic, CVaD group had lower HF HRV vs. NCCP (5.06 ± 1.12 vs. 6.00 ± 1.17, p = 0.007, respectively) and RC (6.04 ± 0.83, p = 0.01) groups. LF/HF ratio did not differ among the three groups.

Conclusions

Women with CVaD demonstrate a greater stress-induced vagal withdrawal compared to those with NCCP and RC women. Further work to investigate altered autonomic responses as a mechanism in CVaD is warranted.

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来源期刊

IJC Heart and Vasculature Medicine-Cardiology and Cardiovascular Medicine

CiteScore

4.90

自引率

10.30%

发文量

216

审稿时长

56 days

期刊介绍： IJC Heart & Vasculature is an online-only, open-access journal dedicated to publishing original articles and reviews (also Editorials and Letters to the Editor) which report on structural and functional cardiovascular pathology, with an emphasis on imaging and disease pathophysiology. Articles must be authentic, educational, clinically relevant, and original in their content and scientific approach. IJC Heart & Vasculature requires the highest standards of scientific integrity in order to promote reliable, reproducible and verifiable research findings. All authors are advised to consult the Principles of Ethical Publishing in the International Journal of Cardiology before submitting a manuscript. Submission of a manuscript to this journal gives the publisher the right to publish that paper if it is accepted. Manuscripts may be edited to improve clarity and expression.