Prognostic implications of mental stress-induced silent left ventricular dysfunction in patients with stable angina pectoris

Am J Cardiol. 1995 Jul 1;76(1):31-5. doi: 10.1016/s0002-9149(99)80796-6.


Thirty patients with stable angina pectoris and ischemia on stress perfusion imaging underwent continuous ambulatory left ventricular (LV) function monitoring. Mental stress was induced by mental arithmetic. Fifteen patients developed transient LV dysfunction during mental arithmetic. Patients were followed for 2 years for adverse cardiac events. Twelve patients had cardiac events over 1 year (myocardial infarction in 4, and unstable angina in 8). Nine of 15 patients (60%) with and only 3 of 15 (20%) without mental stress-induced LV dysfunction developed cardiac events (p = 0.025). A higher proportion of patients with cardiac events were taking beta blockers (p = 0.01) and had lower resting heart rates (p = 0.002) than those without cardiac events. There was no difference in the baseline characteristics between the groups of patients with and without cardiac events. At 2-year follow-up, 10 of 15 patients (67%) with mental stress-induced LV dysfunction had adverse events compared with only 4 of 15 (27%) with no mental stress-induced LV dysfunction (p = 0.025). Thus, in this cohort of patients with stable angina pectoris, mental stress-induced LV dysfunction was associated with higher cardiac events on follow-up. The exact mechanism of this association is not clear. Mental stress may be a trigger for adverse cardiac events in these patients. Transient LV dysfunction in response to mental stress may be a marker of abnormal cardiovascular reactivity to emotional and psychological stimuli in patients with coronary artery disease and may be useful for risk stratification.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use
  • Adult
  • Aged
  • Angina Pectoris / complications
  • Angina Pectoris / diagnostic imaging
  • Angina Pectoris / physiopathology*
  • Angina Pectoris / psychology
  • Electrocardiography, Ambulatory
  • Heart Rate
  • Humans
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • Radionuclide Imaging
  • Stress, Psychological / complications
  • Stress, Psychological / physiopathology*
  • Thallium Radioisotopes
  • Ventricular Dysfunction, Left / complications
  • Ventricular Dysfunction, Left / physiopathology*
  • Ventricular Dysfunction, Left / psychology


  • Adrenergic beta-Antagonists
  • Thallium Radioisotopes