1
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Hu JR, Abdullah A, Nanna MG, Soufer R. The Brain-Heart Axis: Neuroinflammatory Interactions in Cardiovascular Disease. Curr Cardiol Rep 2023; 25:1745-1758. [PMID: 37994952 PMCID: PMC10908342 DOI: 10.1007/s11886-023-01990-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 11/24/2023]
Abstract
PURPOSE OF REVIEW The role of neuroimmune modulation and inflammation in cardiovascular disease has been historically underappreciated. Physiological connections between the heart and brain, termed the heart-brain axis (HBA), are bidirectional, occur through a complex network of autonomic nerves/hormones and cytokines, and play important roles in common disorders. RECENT FINDINGS At the molecular level, advances in the past two decades reveal complex crosstalk mediated by the sympathetic and parasympathetic nervous systems, the renin-angiotensin aldosterone and hypothalamus-pituitary axes, microRNA, and cytokines. Afferent pathways amplify proinflammatory signals via the hypothalamus and brainstem to the periphery, promoting neurogenic inflammation. At the organ level, while stress-mediated cardiomyopathy is the prototypical disorder of the HBA, cardiac dysfunction can result from a myriad of neurologic insults including stroke and spinal injury. Atrial fibrillation is not necessarily a causative factor for cardioembolic stroke, but a manifestation of an abnormal atrial substrate, which can lead to the development of stroke independent of AF. Central and peripheral neurogenic proinflammatory factors have major roles in the HBA, manifesting as complex bi-directional relationships in common conditions such as stroke, arrhythmia, and cardiomyopathy.
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Affiliation(s)
- Jiun-Ruey Hu
- Section of Cardiovascular Medicine, Yale School of Medicine, 789 Howard Ave, New Haven, CT, 06519, USA
| | - Ahmed Abdullah
- Section of Cardiovascular Medicine, Yale School of Medicine, 789 Howard Ave, New Haven, CT, 06519, USA
| | - Michael G Nanna
- Section of Cardiovascular Medicine, Yale School of Medicine, 789 Howard Ave, New Haven, CT, 06519, USA
| | - Robert Soufer
- Section of Cardiovascular Medicine, Yale School of Medicine, 789 Howard Ave, New Haven, CT, 06519, USA.
- VA Connecticut Healthcare System, 950 Campbell Ave, -111B, West Haven, CT, 06516, USA.
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2
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Park DY, Jamil Y, Hu JR, Lowenstern A, Frampton J, Abdullah A, Damluji AA, Ahmad Y, Soufer R, Nanna MG. Delirium in older adults after percutaneous coronary intervention: Prevalence, risks, and clinical phenotypes. Cardiovasc Revasc Med 2023; 57:60-67. [PMID: 37414611 PMCID: PMC10730763 DOI: 10.1016/j.carrev.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/02/2023] [Accepted: 06/13/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION In-hospital delirium is more common among older adults and is associated with increased mortality and adverse health-related outcomes. We aim to establish the contemporary prevalence of delirium among older adults undergoing percutaneous coronary intervention (PCI) and the impact of delirium on in-hospital complications. METHODS We identified older adults aged ≥75 years in the National Inpatient Sample who underwent inpatient PCI for any reason from 2016 to 2020 and stratified them into those with and without delirium. The primary outcome was in-hospital mortality, and secondary outcomes encompassed post-procedural complications. RESULTS Delirium occurred in 14,130 (2.6 %) hospitalizations in which PCI was performed. Patients who developed delirium were older and had more comorbidities. Patients with in-hospital delirium had higher odds of in-hospital mortality (adjusted odds ratio [aOR] 1.27, p = 0.002) and non-home discharge (aOR 3.17, p < 0.001). Delirium was also associated with higher odds of intracranial hemorrhage (aOR 2.49, p < 0.001), gastrointestinal hemorrhage (aOR 1.25, p = 0.030), need for blood transfusion (aOR 1.52, p < 0.001), acute kidney injury (aOR 1.62, p < 0.001), and fall in hospital (aOR 1.97, p < 0.001). CONCLUSION Delirium among older adults undergoing PCI is relatively common and associated with higher odds of in-hospital mortality and adverse events. This highlights the importance of vigilant delirium prevention and early recognition in the peri-procedural setting, especially for older adults.
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Affiliation(s)
- Dae Yong Park
- Department of Medicine, Cook County Health, Chicago, IL, USA
| | - Yasser Jamil
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Jiun-Ruey Hu
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Angela Lowenstern
- Section of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jennifer Frampton
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Ahmed Abdullah
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Abdulla A Damluji
- Johns Hopkins University School of Medicine, Baltimore, MD, USA; Inova Center of Outcomes Research, Falls Church, VA, USA
| | - Yousif Ahmad
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Robert Soufer
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA; Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA; Department of Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - Michael G Nanna
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA.
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Soufer R, Krantz DS. The Interaction of Biology and Emotion: Uncovering a New Phenotype of Nonobstructive Coronary Artery Disease. Biol Psychiatry 2022; 91:606-608. [PMID: 35272766 DOI: 10.1016/j.biopsych.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 11/02/2022]
Affiliation(s)
- Robert Soufer
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut; VA Connecticut Healthcare System, West Haven, Connecticut.
| | - David S Krantz
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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4
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Meadows JL, Shah S, Burg MM, Pfau S, Soufer R. The Foundational Role of Cardiovascular Imaging in the Characterization of Mental Stress-Induced Myocardial Ischemia in Patients with Coronary Artery Disease. Curr Cardiol Rep 2020; 22:162. [PMID: 33037938 DOI: 10.1007/s11886-020-01407-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW Mental stress-provoked myocardial ischemia (MSIMI) is an ischemic phenomenon provoked by the experience of psychologically stressful circumstances. While MSIMI was initially identified 50 years ago during activities of daily living through the use of wearable Holter monitor, subsequent research utilized the technologies of cardiac imaging-ventriculography and myocardial perfusion-under controlled conditions to pursue an understanding of pathophysiology and prognosis. This work revealed that MSIMI occurs in almost half of patients with stable coronary artery disease (CAD) and is associated with cardiac events and early mortality. We provide a focused review of the instrumental role that cardiac imaging has played in elucidating how stress affects cardiac physiology and how emerging diagnostic techniques will allow for further research on stress-mediated changes in the coronary macro- and microvasculature. RECENT FINDINGS Observations about the cardiac response to mental stress diverge from underlying cornerstones of the traditional CAD paradigm which is based upon myocardial oxygen demand and the degree of epicardial coronary stenosis. Evidence from studies utilizing non-invasive and invasive studies of coronary perfusion indicates perturbations in the microvascular compartment in response to mental stress. Cardiovascular imaging enjoined with mental stress provocation may be a commanding tool to advance our understanding of non-obstructive CAD and the coronary microvasculature. This further understanding will facilitate incorporation of mental stress testing in the clinical care of patients with discrepant diagnostic work-up of CAD and in patients who experience anginal symptoms due to non-exertional and/or emotional triggers. Such algorithms will be crucial to identify treatment targets to modify the risk associated with mental stress-associated ischemia and adverse prognosis.
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Affiliation(s)
- Judith L Meadows
- Section of Cardiovascular Medicine, Yale School of Medicine, 950 Campbell Ave. / 111B, West Haven, CT, 06516, USA
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Samit Shah
- Section of Cardiovascular Medicine, Yale School of Medicine, 950 Campbell Ave. / 111B, West Haven, CT, 06516, USA
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Matthew M Burg
- Section of Cardiovascular Medicine, Yale School of Medicine, 950 Campbell Ave. / 111B, West Haven, CT, 06516, USA
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Steven Pfau
- Section of Cardiovascular Medicine, Yale School of Medicine, 950 Campbell Ave. / 111B, West Haven, CT, 06516, USA
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Robert Soufer
- Section of Cardiovascular Medicine, Yale School of Medicine, 950 Campbell Ave. / 111B, West Haven, CT, 06516, USA.
- VA Connecticut Healthcare System, West Haven, CT, USA.
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5
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Shah SM, Meadows JL, Burg MM, Pfau S, Soufer R. Effects of Psychological Stress on Vascular Physiology: Beyond the Current Imaging Signal. Curr Cardiol Rep 2020; 22:156. [PMID: 33037500 DOI: 10.1007/s11886-020-01406-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2020] [Indexed: 01/13/2023]
Abstract
PURPOSE OF REVIEW This review describes the effects of psychological stress on the physiology of the entire vascular system, from individual cellular components to macrovascular and microvascular responses, and highlights the importance of the vascular system in the context of current limitations in cardiac imaging for evaluation of the cardiovascular response to mental stress. RECENT FINDINGS The physiological responses that mediate vascular changes are based on evolutionary needs, but there is increasing evidence that the long-term consequences of psychological stress can precipitate the development and progression of cardiovascular disease (CVD). While there is an extensive body of literature describing localized physiological responses or overt cardiovascular manifestations, often framed within the organ-specific scope of cardiovascular imaging, there has not been a comprehensive description of the global vascular effects of psychological stress. Given the global nature of these processes, targeted cardiovascular imaging modalities may be insufficient. Here we approach the vascular response to mental stress systematically, describing the effects on the endothelium, vascular smooth muscle, and adventitia. We then address the mental stress effects on large vessels and the microvascular compartment, with a discussion of the role of microvascular resistance in the pathophysiology of mental stress-induced myocardial ischemia. Vascular responses to psychological stress involve complex physiological processes that are not fully characterized by routine cardiovascular imaging assessments. Future research incorporating standardized psychological assessments targeted toward vascular mechanisms of stress responses is required to guide the development of behavioral and therapeutic interventions.
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Affiliation(s)
- Samit M Shah
- Section of Cardiovascular Medicine, Yale School of Medicine, 950 Campbell Ave./111B, West Haven, CT, 06516, USA.,VA Connecticut Healthcare System, West Haven, CT, USA
| | - Judith L Meadows
- Section of Cardiovascular Medicine, Yale School of Medicine, 950 Campbell Ave./111B, West Haven, CT, 06516, USA.,VA Connecticut Healthcare System, West Haven, CT, USA
| | - Matthew M Burg
- Section of Cardiovascular Medicine, Yale School of Medicine, 950 Campbell Ave./111B, West Haven, CT, 06516, USA.,VA Connecticut Healthcare System, West Haven, CT, USA
| | - Steven Pfau
- Section of Cardiovascular Medicine, Yale School of Medicine, 950 Campbell Ave./111B, West Haven, CT, 06516, USA.,VA Connecticut Healthcare System, West Haven, CT, USA
| | - Robert Soufer
- Section of Cardiovascular Medicine, Yale School of Medicine, 950 Campbell Ave./111B, West Haven, CT, 06516, USA. .,VA Connecticut Healthcare System, West Haven, CT, USA.
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6
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Jelani QUA, Mena-Hurtado C, Burg M, Soufer R, Gosch K, Jones PG, Spertus JA, Safdar B, Smolderen KG. Relationship Between Depressive Symptoms and Health Status in Peripheral Artery Disease: Role of Sex Differences. J Am Heart Assoc 2020; 9:e014583. [PMID: 32781883 PMCID: PMC7660812 DOI: 10.1161/jaha.119.014583] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background The association of depressive symptoms with health status in peripheral artery disease (PAD) is understudied. No reports of differential impact on women have been described. Methods and Results The PORTRAIT (Patient‐Centered Outcomes Related to Treatment Practices in Peripheral Artery Disease Investigating Trajectories) registry enrolled 1243 patients from vascular specialty clinics with new or worsening PAD symptoms. Depressive symptoms were assessed at baseline and 3 months using the 8‐Item Patient Health Questionnaire (score ≥10 indicating clinically relevant depressive symptoms). Disease‐specific and generic health status were measured by Peripheral Artery Questionnaire and EQ‐5D Visual Analogue Scale at baseline and 3, 6, and 12 months. An adjusted general linear model for repeated measures was constructed for baseline and 3‐, 6‐, and 12‐month health status outcomes by depressive symptoms at baseline. Differences by sex were tested with interaction effects. The mean age was 67.6±9.4 years with 38% (n=470) women. More women than men (21.1% versus 12.9%; P<0.001) presented with severe depressive symptoms. In the adjusted model, patients with depressive symptoms had worse health status at each time point (all P<0.0001). Results were similar for EQ‐5D Visual Analogue Scale scores. The magnitude in 1‐year change in health status scores did not differ by sex. Depressive symptoms explained 19% of the association between sex differences in 1‐year Peripheral Artery Questionnaire summary scores. Conclusions Women with PAD have a high burden of depressive symptoms. Depressive symptoms were associated with a strikingly worse disease‐specific health status recovery path over the year following PAD diagnosis in men and women. Developing and testing interventions to address depressive symptoms in PAD are urgently needed. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01419080.
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Affiliation(s)
- Qurat-Ul-Ain Jelani
- Vascular Medicine Outcomes Program Section of Cardiovascular Medicine Department of Internal Medicine Yale University School of Medicine New Haven CT
| | - Carlos Mena-Hurtado
- Vascular Medicine Outcomes Program Section of Cardiovascular Medicine Department of Internal Medicine Yale University School of Medicine New Haven CT
| | - Matthew Burg
- Department of Internal Medicine Yale University School of Medicine New Haven CT
| | - Robert Soufer
- Cardiovascular Medicine VA Connecticut Healthcare System West Haven CT
| | - Kensey Gosch
- Saint Luke's Mid America Heart Institute Kansas City MO
| | - Philip G Jones
- Saint Luke's Mid America Heart Institute Kansas City MO.,University of Missouri-Kansas City MO
| | - John A Spertus
- Saint Luke's Mid America Heart Institute Kansas City MO.,University of Missouri-Kansas City MO
| | - Basmah Safdar
- Department of Emergency Medicine Yale School of Medicine New Haven CT
| | - Kim G Smolderen
- Vascular Medicine Outcomes Program Section of Cardiovascular Medicine Department of Internal Medicine Yale University School of Medicine New Haven CT
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7
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Abstract
Central activation in response to emotion and cognitive stress induces perturbations in the heart and the peripheral vasculature that differ in physiology and clinical manifestations when compared with exercise-induced changes. While our conventional framework of epicardial coronary artery disease is foundational in cardiology, an expanded paradigm is required to address the cardiovascular response to mental stress (MS) and its associated risks, thus addressing the intersection of the patient's ecological and psychosocial experience with cardiovascular biology. To advance the field of MS in cardiovascular health, certain core challenges must be addressed. These include differences in the trigger activation between exercise and emotion, identification and interpretation of imaging cues as measures of pathophysiologic changes, characterization of the vascular response, and identification of central and peripheral treatment targets. Sex and psychosocial determinants of health are important in understanding the emerging overlap of MS-induced myocardial ischemia with microvascular dysfunction and symptoms in the absence of obstructive disease. In overcoming these critical knowledge gaps, integration of the field of MS will require implementation studies to guide use of MS testing, to support diagnosis of MS induced cardiac and vascular pathophysiology, to assess prognosis, and understand the role of endotying to direct therapy.
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Affiliation(s)
- Judith L Meadows
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (J.L.M., S.S., M.M.B., S.P., R.S.).,VA Connecticut Healthcare System, West Haven, CT (J.L.M., S.S., M.M.B., S.P., R.S.)
| | - Samit Shah
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (J.L.M., S.S., M.M.B., S.P., R.S.).,VA Connecticut Healthcare System, West Haven, CT (J.L.M., S.S., M.M.B., S.P., R.S.)
| | - Matthew M Burg
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (J.L.M., S.S., M.M.B., S.P., R.S.).,VA Connecticut Healthcare System, West Haven, CT (J.L.M., S.S., M.M.B., S.P., R.S.)
| | - Steven Pfau
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (J.L.M., S.S., M.M.B., S.P., R.S.).,VA Connecticut Healthcare System, West Haven, CT (J.L.M., S.S., M.M.B., S.P., R.S.)
| | - Robert Soufer
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (J.L.M., S.S., M.M.B., S.P., R.S.).,VA Connecticut Healthcare System, West Haven, CT (J.L.M., S.S., M.M.B., S.P., R.S.)
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8
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Lampert R, Burg MM, Jamner LD, Dziura J, Brandt C, Li F, Donovan T, Soufer R. Effect of β-blockers on triggering of symptomatic atrial fibrillation by anger or stress. Heart Rhythm 2019; 16:1167-1173. [PMID: 31171436 DOI: 10.1016/j.hrthm.2019.03.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Anger and stress can trigger episodes of atrial fibrillation (AF) in patients with a history of AF. OBJECTIVE The purpose of this study was to determine whether β-blockers can protect against emotionally triggered AF. METHODS In this prospective, controlled, electronic diary-based study of emotions preceding AF, patients with a history of paroxysmal or persistent AF (N = 91) recorded their rhythm on event monitors at the time of AF symptoms and completed a diary entry querying mood states (eg, anger and stress) for the preceding 30 minutes (pre-AF "case period") for 1 year. Also, patients underwent monthly 24-hour Holter monitoring during which they were prompted to complete a diary entry twice per hour. Diaries recorded during sinus rhythm comprise controls. Patients' exposure to each emotion was compared between the pre-AF case period and control periods by using generalized estimating equation modeling, as well as interactions between β-blocker use and emotion tested. RESULTS Sixty percent were prescribed β-blockers. A total of 163 symptomatic AF episodes (in 34 patients) and 11,563 Holter-confirmed sinus rhythm control periods had associated diary data. Overall, the likelihood of an AF episode was significantly higher during anger or stress. This effect, however, was significantly attenuated in patients on β-blockers (odds ratio 22.5; 95% confidence interval 6.7-75.4, P < .0001 for patients not prescribed β-blockers vs odds ratio 4.0, 95% confidence interval 1.7-9.5, P = .002 for those prescribed β-blockers; P = .02 for the interaction). Exclusion of patients on sotalol did not affect findings. CONCLUSION Anger or stress can trigger AF, but use of β-blockers greatly attenuates this deleterious physiological response.
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Affiliation(s)
- Rachel Lampert
- Department of Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven Connecticut.
| | - Matthew M Burg
- Department of Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven Connecticut
| | - Larry D Jamner
- Department of Psychological Science, School of Social Ecology, University of California, Irvine, Irvine, California
| | - James Dziura
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Cynthia Brandt
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut; Department of Medicine, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Fangyong Li
- Yale University School of Public Health, Department of Biostatistics, New Haven, Connecticut
| | - Theresa Donovan
- Department of Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven Connecticut
| | - Robert Soufer
- Department of Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven Connecticut
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9
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Soufer R, Burg MM. The interface of emotion and biology in myocardial ischemia: Can we progress using the traditional paradigm? J Nucl Cardiol 2017; 24:783-787. [PMID: 28155190 DOI: 10.1007/s12350-016-0762-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 08/12/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Robert Soufer
- Department of Cardiology, Yale University, 950 Campbell Avenue, West Haven, CT, 06516, USA.
| | - Matthew M Burg
- Department of Cardiology, Yale University, 950 Campbell Avenue, West Haven, CT, 06516, USA
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10
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Ceneri N, Zhao L, Young BD, Healy A, Coskun S, Vasavada H, Yarovinsky TO, Ike K, Pardi R, Qin L, Qin L, Tellides G, Hirschi K, Meadows J, Soufer R, Chun HJ, Sadeghi MM, Bender JR, Morrison AR. Rac2 Modulates Atherosclerotic Calcification by Regulating Macrophage Interleukin-1β Production. Arterioscler Thromb Vasc Biol 2017; 37:328-340. [PMID: 27834690 PMCID: PMC5269510 DOI: 10.1161/atvbaha.116.308507] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 10/27/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The calcium composition of atherosclerotic plaque is thought to be associated with increased risk for cardiovascular events, but whether plaque calcium itself is predictive of worsening clinical outcomes remains highly controversial. Inflammation is likely a key mediator of vascular calcification, but immune signaling mechanisms that promote this process are minimally understood. APPROACH AND RESULTS Here, we identify Rac2 as a major inflammatory regulator of signaling that directs plaque osteogenesis. In experimental atherogenesis, Rac2 prevented progressive calcification through its suppression of Rac1-dependent macrophage interleukin-1β (IL-1β) expression, which in turn is a key driver of vascular smooth muscle cell calcium deposition by its ability to promote osteogenic transcriptional programs. Calcified coronary arteries from patients revealed decreased Rac2 expression but increased IL-1β expression, and high coronary calcium burden in patients with coronary artery disease was associated with significantly increased serum IL-1β levels. Moreover, we found that elevated IL-1β was an independent predictor of cardiovascular death in those subjects with high coronary calcium burden. CONCLUSIONS Overall, these studies identify a novel Rac2-mediated regulation of macrophage IL-1β expression, which has the potential to serve as a powerful biomarker and therapeutic target for atherosclerosis.
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MESH Headings
- Animals
- Aorta/enzymology
- Aorta/pathology
- Aortic Diseases/enzymology
- Aortic Diseases/genetics
- Aortic Diseases/pathology
- Aortic Diseases/prevention & control
- Apolipoproteins E/deficiency
- Apolipoproteins E/genetics
- Atherosclerosis/enzymology
- Atherosclerosis/genetics
- Atherosclerosis/pathology
- Atherosclerosis/prevention & control
- Cells, Cultured
- Coronary Artery Disease/enzymology
- Coronary Artery Disease/mortality
- Coronary Artery Disease/pathology
- Coronary Vessels/enzymology
- Coronary Vessels/pathology
- Female
- Genetic Predisposition to Disease
- Humans
- Inflammation Mediators/metabolism
- Interleukin 1 Receptor Antagonist Protein/pharmacology
- Interleukin-1beta/metabolism
- Macrophages/enzymology
- Macrophages/pathology
- Male
- Mice, Inbred C57BL
- Mice, Knockout
- Muscle, Smooth, Vascular/enzymology
- Muscle, Smooth, Vascular/pathology
- Myocytes, Smooth Muscle/enzymology
- Myocytes, Smooth Muscle/pathology
- Neuropeptides/metabolism
- Phenotype
- Plaque, Atherosclerotic
- Prognosis
- Signal Transduction
- Transfection
- Up-Regulation
- Vascular Calcification/enzymology
- Vascular Calcification/mortality
- Vascular Calcification/pathology
- rac GTP-Binding Proteins/deficiency
- rac GTP-Binding Proteins/genetics
- rac GTP-Binding Proteins/metabolism
- rac1 GTP-Binding Protein/metabolism
- RAC2 GTP-Binding Protein
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Affiliation(s)
- Nicolle Ceneri
- From the Department of Internal Medicine (Section of Cardiovascular Medicine), VA Connecticut Healthcare System, West Haven (N.C., L.Z., A.H., L.Q., G.T., J.M., R.S., M.M.S., A.R.M.); Department of Medicine and Division of Cardiology, Providence VA Medical Center, RI (A.H., A.R.M.); Department of Internal Medicine (Section of Cardiovascular Medicine), Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, CT (N.C., L.Z., B.D.Y., A.H., S.C., H.V., T.O.Y., K.I., L.Q., L.Q., G.T., K.H., J.M., R.S., H.J.C., M.M.S., J.R.B, A.R.M.); Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI (A.H., A.R.M.); and Department of Molecular Pathology, Universita Vita Salute School of Medicine, San Raffaele Scientific Institute, Milan, Italy (R.P.)
| | - Lina Zhao
- From the Department of Internal Medicine (Section of Cardiovascular Medicine), VA Connecticut Healthcare System, West Haven (N.C., L.Z., A.H., L.Q., G.T., J.M., R.S., M.M.S., A.R.M.); Department of Medicine and Division of Cardiology, Providence VA Medical Center, RI (A.H., A.R.M.); Department of Internal Medicine (Section of Cardiovascular Medicine), Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, CT (N.C., L.Z., B.D.Y., A.H., S.C., H.V., T.O.Y., K.I., L.Q., L.Q., G.T., K.H., J.M., R.S., H.J.C., M.M.S., J.R.B, A.R.M.); Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI (A.H., A.R.M.); and Department of Molecular Pathology, Universita Vita Salute School of Medicine, San Raffaele Scientific Institute, Milan, Italy (R.P.)
| | - Bryan D Young
- From the Department of Internal Medicine (Section of Cardiovascular Medicine), VA Connecticut Healthcare System, West Haven (N.C., L.Z., A.H., L.Q., G.T., J.M., R.S., M.M.S., A.R.M.); Department of Medicine and Division of Cardiology, Providence VA Medical Center, RI (A.H., A.R.M.); Department of Internal Medicine (Section of Cardiovascular Medicine), Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, CT (N.C., L.Z., B.D.Y., A.H., S.C., H.V., T.O.Y., K.I., L.Q., L.Q., G.T., K.H., J.M., R.S., H.J.C., M.M.S., J.R.B, A.R.M.); Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI (A.H., A.R.M.); and Department of Molecular Pathology, Universita Vita Salute School of Medicine, San Raffaele Scientific Institute, Milan, Italy (R.P.)
| | - Abigail Healy
- From the Department of Internal Medicine (Section of Cardiovascular Medicine), VA Connecticut Healthcare System, West Haven (N.C., L.Z., A.H., L.Q., G.T., J.M., R.S., M.M.S., A.R.M.); Department of Medicine and Division of Cardiology, Providence VA Medical Center, RI (A.H., A.R.M.); Department of Internal Medicine (Section of Cardiovascular Medicine), Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, CT (N.C., L.Z., B.D.Y., A.H., S.C., H.V., T.O.Y., K.I., L.Q., L.Q., G.T., K.H., J.M., R.S., H.J.C., M.M.S., J.R.B, A.R.M.); Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI (A.H., A.R.M.); and Department of Molecular Pathology, Universita Vita Salute School of Medicine, San Raffaele Scientific Institute, Milan, Italy (R.P.)
| | - Suleyman Coskun
- From the Department of Internal Medicine (Section of Cardiovascular Medicine), VA Connecticut Healthcare System, West Haven (N.C., L.Z., A.H., L.Q., G.T., J.M., R.S., M.M.S., A.R.M.); Department of Medicine and Division of Cardiology, Providence VA Medical Center, RI (A.H., A.R.M.); Department of Internal Medicine (Section of Cardiovascular Medicine), Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, CT (N.C., L.Z., B.D.Y., A.H., S.C., H.V., T.O.Y., K.I., L.Q., L.Q., G.T., K.H., J.M., R.S., H.J.C., M.M.S., J.R.B, A.R.M.); Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI (A.H., A.R.M.); and Department of Molecular Pathology, Universita Vita Salute School of Medicine, San Raffaele Scientific Institute, Milan, Italy (R.P.)
| | - Hema Vasavada
- From the Department of Internal Medicine (Section of Cardiovascular Medicine), VA Connecticut Healthcare System, West Haven (N.C., L.Z., A.H., L.Q., G.T., J.M., R.S., M.M.S., A.R.M.); Department of Medicine and Division of Cardiology, Providence VA Medical Center, RI (A.H., A.R.M.); Department of Internal Medicine (Section of Cardiovascular Medicine), Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, CT (N.C., L.Z., B.D.Y., A.H., S.C., H.V., T.O.Y., K.I., L.Q., L.Q., G.T., K.H., J.M., R.S., H.J.C., M.M.S., J.R.B, A.R.M.); Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI (A.H., A.R.M.); and Department of Molecular Pathology, Universita Vita Salute School of Medicine, San Raffaele Scientific Institute, Milan, Italy (R.P.)
| | - Timur O Yarovinsky
- From the Department of Internal Medicine (Section of Cardiovascular Medicine), VA Connecticut Healthcare System, West Haven (N.C., L.Z., A.H., L.Q., G.T., J.M., R.S., M.M.S., A.R.M.); Department of Medicine and Division of Cardiology, Providence VA Medical Center, RI (A.H., A.R.M.); Department of Internal Medicine (Section of Cardiovascular Medicine), Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, CT (N.C., L.Z., B.D.Y., A.H., S.C., H.V., T.O.Y., K.I., L.Q., L.Q., G.T., K.H., J.M., R.S., H.J.C., M.M.S., J.R.B, A.R.M.); Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI (A.H., A.R.M.); and Department of Molecular Pathology, Universita Vita Salute School of Medicine, San Raffaele Scientific Institute, Milan, Italy (R.P.)
| | - Kenneth Ike
- From the Department of Internal Medicine (Section of Cardiovascular Medicine), VA Connecticut Healthcare System, West Haven (N.C., L.Z., A.H., L.Q., G.T., J.M., R.S., M.M.S., A.R.M.); Department of Medicine and Division of Cardiology, Providence VA Medical Center, RI (A.H., A.R.M.); Department of Internal Medicine (Section of Cardiovascular Medicine), Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, CT (N.C., L.Z., B.D.Y., A.H., S.C., H.V., T.O.Y., K.I., L.Q., L.Q., G.T., K.H., J.M., R.S., H.J.C., M.M.S., J.R.B, A.R.M.); Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI (A.H., A.R.M.); and Department of Molecular Pathology, Universita Vita Salute School of Medicine, San Raffaele Scientific Institute, Milan, Italy (R.P.)
| | - Ruggero Pardi
- From the Department of Internal Medicine (Section of Cardiovascular Medicine), VA Connecticut Healthcare System, West Haven (N.C., L.Z., A.H., L.Q., G.T., J.M., R.S., M.M.S., A.R.M.); Department of Medicine and Division of Cardiology, Providence VA Medical Center, RI (A.H., A.R.M.); Department of Internal Medicine (Section of Cardiovascular Medicine), Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, CT (N.C., L.Z., B.D.Y., A.H., S.C., H.V., T.O.Y., K.I., L.Q., L.Q., G.T., K.H., J.M., R.S., H.J.C., M.M.S., J.R.B, A.R.M.); Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI (A.H., A.R.M.); and Department of Molecular Pathology, Universita Vita Salute School of Medicine, San Raffaele Scientific Institute, Milan, Italy (R.P.)
| | - Lingfen Qin
- From the Department of Internal Medicine (Section of Cardiovascular Medicine), VA Connecticut Healthcare System, West Haven (N.C., L.Z., A.H., L.Q., G.T., J.M., R.S., M.M.S., A.R.M.); Department of Medicine and Division of Cardiology, Providence VA Medical Center, RI (A.H., A.R.M.); Department of Internal Medicine (Section of Cardiovascular Medicine), Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, CT (N.C., L.Z., B.D.Y., A.H., S.C., H.V., T.O.Y., K.I., L.Q., L.Q., G.T., K.H., J.M., R.S., H.J.C., M.M.S., J.R.B, A.R.M.); Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI (A.H., A.R.M.); and Department of Molecular Pathology, Universita Vita Salute School of Medicine, San Raffaele Scientific Institute, Milan, Italy (R.P.)
| | - Li Qin
- From the Department of Internal Medicine (Section of Cardiovascular Medicine), VA Connecticut Healthcare System, West Haven (N.C., L.Z., A.H., L.Q., G.T., J.M., R.S., M.M.S., A.R.M.); Department of Medicine and Division of Cardiology, Providence VA Medical Center, RI (A.H., A.R.M.); Department of Internal Medicine (Section of Cardiovascular Medicine), Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, CT (N.C., L.Z., B.D.Y., A.H., S.C., H.V., T.O.Y., K.I., L.Q., L.Q., G.T., K.H., J.M., R.S., H.J.C., M.M.S., J.R.B, A.R.M.); Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI (A.H., A.R.M.); and Department of Molecular Pathology, Universita Vita Salute School of Medicine, San Raffaele Scientific Institute, Milan, Italy (R.P.)
| | - George Tellides
- From the Department of Internal Medicine (Section of Cardiovascular Medicine), VA Connecticut Healthcare System, West Haven (N.C., L.Z., A.H., L.Q., G.T., J.M., R.S., M.M.S., A.R.M.); Department of Medicine and Division of Cardiology, Providence VA Medical Center, RI (A.H., A.R.M.); Department of Internal Medicine (Section of Cardiovascular Medicine), Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, CT (N.C., L.Z., B.D.Y., A.H., S.C., H.V., T.O.Y., K.I., L.Q., L.Q., G.T., K.H., J.M., R.S., H.J.C., M.M.S., J.R.B, A.R.M.); Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI (A.H., A.R.M.); and Department of Molecular Pathology, Universita Vita Salute School of Medicine, San Raffaele Scientific Institute, Milan, Italy (R.P.)
| | - Karen Hirschi
- From the Department of Internal Medicine (Section of Cardiovascular Medicine), VA Connecticut Healthcare System, West Haven (N.C., L.Z., A.H., L.Q., G.T., J.M., R.S., M.M.S., A.R.M.); Department of Medicine and Division of Cardiology, Providence VA Medical Center, RI (A.H., A.R.M.); Department of Internal Medicine (Section of Cardiovascular Medicine), Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, CT (N.C., L.Z., B.D.Y., A.H., S.C., H.V., T.O.Y., K.I., L.Q., L.Q., G.T., K.H., J.M., R.S., H.J.C., M.M.S., J.R.B, A.R.M.); Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI (A.H., A.R.M.); and Department of Molecular Pathology, Universita Vita Salute School of Medicine, San Raffaele Scientific Institute, Milan, Italy (R.P.)
| | - Judith Meadows
- From the Department of Internal Medicine (Section of Cardiovascular Medicine), VA Connecticut Healthcare System, West Haven (N.C., L.Z., A.H., L.Q., G.T., J.M., R.S., M.M.S., A.R.M.); Department of Medicine and Division of Cardiology, Providence VA Medical Center, RI (A.H., A.R.M.); Department of Internal Medicine (Section of Cardiovascular Medicine), Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, CT (N.C., L.Z., B.D.Y., A.H., S.C., H.V., T.O.Y., K.I., L.Q., L.Q., G.T., K.H., J.M., R.S., H.J.C., M.M.S., J.R.B, A.R.M.); Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI (A.H., A.R.M.); and Department of Molecular Pathology, Universita Vita Salute School of Medicine, San Raffaele Scientific Institute, Milan, Italy (R.P.)
| | - Robert Soufer
- From the Department of Internal Medicine (Section of Cardiovascular Medicine), VA Connecticut Healthcare System, West Haven (N.C., L.Z., A.H., L.Q., G.T., J.M., R.S., M.M.S., A.R.M.); Department of Medicine and Division of Cardiology, Providence VA Medical Center, RI (A.H., A.R.M.); Department of Internal Medicine (Section of Cardiovascular Medicine), Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, CT (N.C., L.Z., B.D.Y., A.H., S.C., H.V., T.O.Y., K.I., L.Q., L.Q., G.T., K.H., J.M., R.S., H.J.C., M.M.S., J.R.B, A.R.M.); Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI (A.H., A.R.M.); and Department of Molecular Pathology, Universita Vita Salute School of Medicine, San Raffaele Scientific Institute, Milan, Italy (R.P.)
| | - Hyung J Chun
- From the Department of Internal Medicine (Section of Cardiovascular Medicine), VA Connecticut Healthcare System, West Haven (N.C., L.Z., A.H., L.Q., G.T., J.M., R.S., M.M.S., A.R.M.); Department of Medicine and Division of Cardiology, Providence VA Medical Center, RI (A.H., A.R.M.); Department of Internal Medicine (Section of Cardiovascular Medicine), Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, CT (N.C., L.Z., B.D.Y., A.H., S.C., H.V., T.O.Y., K.I., L.Q., L.Q., G.T., K.H., J.M., R.S., H.J.C., M.M.S., J.R.B, A.R.M.); Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI (A.H., A.R.M.); and Department of Molecular Pathology, Universita Vita Salute School of Medicine, San Raffaele Scientific Institute, Milan, Italy (R.P.)
| | - Mehran M Sadeghi
- From the Department of Internal Medicine (Section of Cardiovascular Medicine), VA Connecticut Healthcare System, West Haven (N.C., L.Z., A.H., L.Q., G.T., J.M., R.S., M.M.S., A.R.M.); Department of Medicine and Division of Cardiology, Providence VA Medical Center, RI (A.H., A.R.M.); Department of Internal Medicine (Section of Cardiovascular Medicine), Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, CT (N.C., L.Z., B.D.Y., A.H., S.C., H.V., T.O.Y., K.I., L.Q., L.Q., G.T., K.H., J.M., R.S., H.J.C., M.M.S., J.R.B, A.R.M.); Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI (A.H., A.R.M.); and Department of Molecular Pathology, Universita Vita Salute School of Medicine, San Raffaele Scientific Institute, Milan, Italy (R.P.)
| | - Jeffrey R Bender
- From the Department of Internal Medicine (Section of Cardiovascular Medicine), VA Connecticut Healthcare System, West Haven (N.C., L.Z., A.H., L.Q., G.T., J.M., R.S., M.M.S., A.R.M.); Department of Medicine and Division of Cardiology, Providence VA Medical Center, RI (A.H., A.R.M.); Department of Internal Medicine (Section of Cardiovascular Medicine), Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, CT (N.C., L.Z., B.D.Y., A.H., S.C., H.V., T.O.Y., K.I., L.Q., L.Q., G.T., K.H., J.M., R.S., H.J.C., M.M.S., J.R.B, A.R.M.); Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI (A.H., A.R.M.); and Department of Molecular Pathology, Universita Vita Salute School of Medicine, San Raffaele Scientific Institute, Milan, Italy (R.P.)
| | - Alan R Morrison
- From the Department of Internal Medicine (Section of Cardiovascular Medicine), VA Connecticut Healthcare System, West Haven (N.C., L.Z., A.H., L.Q., G.T., J.M., R.S., M.M.S., A.R.M.); Department of Medicine and Division of Cardiology, Providence VA Medical Center, RI (A.H., A.R.M.); Department of Internal Medicine (Section of Cardiovascular Medicine), Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, CT (N.C., L.Z., B.D.Y., A.H., S.C., H.V., T.O.Y., K.I., L.Q., L.Q., G.T., K.H., J.M., R.S., H.J.C., M.M.S., J.R.B, A.R.M.); Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI (A.H., A.R.M.); and Department of Molecular Pathology, Universita Vita Salute School of Medicine, San Raffaele Scientific Institute, Milan, Italy (R.P.).
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Soufer R, Fernandez AB, Meadows J, Collins D, Burg MM. Body Mass Index and Risk for Mental Stress Induced Ischemia in Coronary Artery Disease. Mol Med 2016; 22:286-291. [PMID: 27261777 DOI: 10.2119/molmed.2016.00128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 05/12/2016] [Indexed: 11/06/2022] Open
Abstract
Acute emotionally reactive mental stress (MS) can provoke prognostically relevant deficits in cardiac function and myocardial perfusion, and chronic inflammation increases risk for this ischemic phenomenon. We have described parasympathetic withdrawal and generation of inflammatory factors in MS. Adiposity is also associated with elevated markers of chronic inflammation. High body mass index (BMI) is frequently used as a surrogate for assessment of excess adiposity, and associated with traditional CAD risk factors, and CAD mortality. BMI is also associated with autonomic dysregulation, adipose tissue derived proinflammatory cytokines, which are also attendant to emotion provoked myocardial ischemia. Thus, we sought to determine if body mass index (BMI) contributes to risk of developing myocardial ischemia provoked by mental stress. We performed a prospective interventional study in a cohort of 161 patients with stable CAD. They completed an assessment of myocardial blood flow with single photon emission computed tomography (SPECT) simultaneously during 2 conditions: laboratory mental stress and at rest. Multivariate logistic regression determined the independent contribution of BMI to the occurrence of mental-stress induced ischemia. Mean age was 65.6 ±9.0 years; 87.0% had a history of hypertension, and 28.6% had diabetes. Mean BMI was 30.4 ± 4.7. Prevalence of mental stress ischemia was 39.8%. BMI was an independent predictor of mental stress ischemia, OR=1.10, 95% CI [1.01-1.18] for one-point increase in BMI and OR=1.53, 95% CI [1.06-2.21] for a 4.7 point increase in BMI (one standard deviation beyond the cohort BMI mean), p=0.025 for all. These data suggest that BMI may serve as an independent risk marker for mental stress ischemia. The factors attendant with greater BMI, which include autonomic dysregulation and inflammation, may represent pathways by which high BMI contribute to this risk and serve as a conceptual construct to replicate these findings in larger CAD populations.
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Affiliation(s)
- Robert Soufer
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA.,VA Connecticut Healthcare System, West Haven Campus, West Haven, CT, USA
| | - Antonio B Fernandez
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Judith Meadows
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA.,VA Connecticut Healthcare System, West Haven Campus, West Haven, CT, USA
| | - Dorothea Collins
- VA Connecticut Healthcare System, West Haven Campus, West Haven, CT, USA
| | - Matthew M Burg
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA.,VA Connecticut Healthcare System, West Haven Campus, West Haven, CT, USA
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Ceneri N, Zhao L, Young BD, Healy AL, Coskun S, Vasavada H, Yarovinsky TIO, Ike K, Qin L, Pardi R, Meadows J, Tellides G, Hirschi K, Soufer R, Sadeghi M, Bender JR, Morrison AR. Abstract 655: Rac2 is a Key Modulator of IL-1β -dependent Atherosclerotic Plaque Calcification. Arterioscler Thromb Vasc Biol 2016. [DOI: 10.1161/atvb.36.suppl_1.655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The calcium composition of atherosclerotic plaque has predictive value for increased risk of cardiovascular events. Inflammation is associated with atherosclerotic calcification, but the immune signaling that regulates calcium mineralization in plaque is minimally understood. The hematopoietic Rac family member, Rac2, modulates the activation of immune cells and has potential to influence plaque osteogenesis. Both aortic plaque from
ApoE
-/-
mice fed a high fat diet and coronary plaque from patients revealed increased Rac1:Rac2 expression ratios, driven by dynamic Rac2 expression, to be associated with calcified plaque. On high fat diet,
Rac2
-/-
ApoE
-/-
mice demonstrated comparable serum cholesterol and plaque burden relative to
ApoE
-/-
mice, but histology identified differences in plaque structure and cellularity. MicroCT and calcium-targeted imaging identified increased atherosclerotic calcification, which was associated with elevated expression of osteogenic transcription factors and was dependent on the hematopoietic compartment. Calcified plaque expressed higher IL-1β mRNA levels, and serum revealed increased IL-1β protein concentrations.
Rac2
-/-
ApoE
-/-
macrophages demonstrated increased activation of Rac1 and consequent Rac1-dependent IL-1β secretion. Downstream of Rac1, NF-κB and reactive oxygen species (ROS) signaling drove IL-1β production by increasing IL-1β mRNA expression and caspase1 activation. Cultured mouse aorta smooth muscle cells mineralized calcium in an IL-1β dose-dependent manner, and the enhanced atherosclerotic calcification
in vivo
was inhibited by IL-1 receptor antagonist, confirming a cause-and-effect relationship. In patients with stable coronary artery disease, high coronary calcium burden was associated with increased serum IL-1β, and patients with combined elevations in calcium and IL-1β had more events driven by higher mortality, reinforcing the relevance of this inflammatory calcification signaling axis to human disease. Therapeutic targeting of IL-1β expression through the balance of Rac activation has potential to impact patient care by modulating atherosclerotic calcification and consequent cardiovascular events.
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Affiliation(s)
| | - Lina Zhao
- Medicine, Yale Univ Sch of Medicine, New Haven, CT
| | | | | | | | | | | | - Kenneth Ike
- Medicine, Yale Univ Sch of Medicine, New Haven, CT
| | - Lingfen Qin
- Medicine, Yale Univ Sch of Medicine, New Haven, CT
| | - Ruggero Pardi
- Molecular Pathology, Universita Vita Salute Sch of Medicine, San Raffaele Scientific Institute, Milan, Italy
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Burg MM, Meadows J, Shimbo D, Davidson KW, Schwartz JE, Soufer R. Confluence of depression and acute psychological stress among patients with stable coronary heart disease: effects on myocardial perfusion. J Am Heart Assoc 2014; 3:e000898. [PMID: 25359402 PMCID: PMC4338683 DOI: 10.1161/jaha.114.000898] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Depression is prevalent in coronary heart disease (CHD) patients and increases risk for acute coronary syndrome (ACS) recurrence and mortality despite optimal medical care. The pathways underlying this risk remain elusive. Psychological stress (PS) can provoke impairment in myocardial perfusion and trigger ACS. A confluence of acute PS with depression might reveal coronary vascular mechanisms of risk. We tested whether depression increased risk for impaired myocardial perfusion during acute PS among patients with stable CHD. Methods and Results Patients (N=146) completed the Beck Depression Inventory‐I (BDI‐I), a measure of depression linked to recurrent ACS and post‐ACS mortality, and underwent single‐photon emission computed tomography myocardial perfusion imaging at rest and during acute PS. The likelihood of new/worsening impairment in myocardial perfusion from baseline to PS as a function of depression severity was tested. On the BDI‐I, 41 patients scored in the normal range, 48 in the high normal range, and 57 in the depressed range previously linked to CHD prognosis. A BDI‐I score in the depressed range was associated with a significantly greater likelihood of new/worsening impairment in myocardial perfusion from baseline to PS (odds ratio =2.89, 95% CI: 1.26 to 6.63, P=0.012). This remained significant in models controlling ACS recurrence/mortality risk factors and medications. There was no effect for selective serotonin reuptake inhibitor medications. Conclusions Depressed patients with CHD are particularly susceptible to impairment in myocardial perfusion during PS. The confluence of PS with depression may contribute to a better understanding of the depression‐associated risk for ACS recurrence and mortality.
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Affiliation(s)
- Matthew M Burg
- Section of Cardiovascular Medicine, VA Connecticut, West Haven, CT (M.M.B., J.M., R.S.) Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (M.M.B., J.M., R.S.) Center for Behavioral Cardiovascular Health, Columbia University School of Medicine, New York, NY (M.M.B., D.S., K.W.D., J.E.S.)
| | - Judith Meadows
- Section of Cardiovascular Medicine, VA Connecticut, West Haven, CT (M.M.B., J.M., R.S.) Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (M.M.B., J.M., R.S.)
| | - Daichi Shimbo
- Center for Behavioral Cardiovascular Health, Columbia University School of Medicine, New York, NY (M.M.B., D.S., K.W.D., J.E.S.)
| | - Karina W Davidson
- Center for Behavioral Cardiovascular Health, Columbia University School of Medicine, New York, NY (M.M.B., D.S., K.W.D., J.E.S.)
| | - Joseph E Schwartz
- Center for Behavioral Cardiovascular Health, Columbia University School of Medicine, New York, NY (M.M.B., D.S., K.W.D., J.E.S.)
| | - Robert Soufer
- Section of Cardiovascular Medicine, VA Connecticut, West Haven, CT (M.M.B., J.M., R.S.) Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (M.M.B., J.M., R.S.)
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Lampert R, Jamner L, Burg M, Dziura J, Brandt C, Liu H, Li F, Donovan T, Soufer R. Triggering of Symptomatic Atrial Fibrillation by Negative Emotion. J Am Coll Cardiol 2014; 64:1533-4. [DOI: 10.1016/j.jacc.2014.07.959] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 07/01/2014] [Accepted: 07/08/2014] [Indexed: 11/26/2022]
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Abisse SS, Lampert R, Burg M, Soufer R, Shusterman V. Cardiac repolarization instability during psychological stress in patients with ventricular arrhythmias. J Electrocardiol 2011; 44:678-83. [PMID: 21920534 DOI: 10.1016/j.jelectrocard.2011.07.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2011] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Changes in the autonomic nervous system activity are a major trigger of life-threatening ventricular tachyarrhythmias (VTAs). Mental arithmetic, a condition administered in a laboratory setting, can provide insight into the autonomic nervous system activity effects on cardiac physiology. We examined the responses of cardiac repolarization to laboratory-induced psychological stressors in patients with implantable cardioverter-defibrillators (ICDs) with the objective of identifying the indices that differentiate patients with and without subsequent VTA in follow-up. METHODS Continuous electrocardiographic signals were recorded using 3 standard bipolar (Holter) leads in 56 patients (age, 63.6 ± 11.9; female, 12%; left ventricular ejection fraction, 32.3 ± 11) with ICDs during mental arithmetic. The patients were separated into those with subsequent VTA during 3 to 4 years of follow-up (group 1: n = 9) and those without VTA (group 2: n = 47). Changes in repolarization (QT interval, mean T wave amplitude [Tamp], and T wave area) were analyzed during 5 minutes at baseline, stress, and recovery. The temporal instability of Tamp and T wave area was examined using the range (Δ) and variance (σ(2)) of beat-to-beat variations of the corresponding parameters. RESULTS There were no significant differences in heart rate between the 2 groups at baseline (61 vs 63 beats per minute, P = .97), stress (64 vs 65 beats per minute, P = .40), and recovery (62 vs 61 beats per minute, P = .88). However, during mental stress and poststress recovery, ΔTamp was almost 2-fold greater in group 1 compared with group 2 (111 [57-203] vs 68 [44-94] μV, P = .04, respectively). Changes in QT intervals were also greater in group 1 compared with group 2 (P = .02). CONCLUSION Among patients with ICDs, changes of Tamp after psychological stress were greater in those with subsequent arrhythmic events. This might signal proarrhythmic repolarization response and help identify patients who would benefit the most from ICD implantation and proactive management.
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Affiliation(s)
- Saddam S Abisse
- Cardiovascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Burg MM, Soufer A, Lampert R, Collins D, Soufer R. Autonomic contribution to endothelin-1 increase during laboratory anger-recall stress in patients with coronary artery disease. Mol Med 2011; 17:495-501. [PMID: 21267513 DOI: 10.2119/molmed.2010.00083] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Accepted: 01/14/2011] [Indexed: 01/08/2023] Open
Abstract
In coronary artery disease (CAD), endothelin-1 (ET-1) is released by activated macrophages and thereby contributes to coronary plaque rupture and triggered cardiac events. The multifactorial regulation of ET-1 includes stimulated release by cytokines and autonomic factors. Laboratory stress provokes alteration in autonomic tone and prolonged ET-1 mediated endothelial dysfunction. The objective of the study is to determine the autonomic contribution to an increase in ET-1 in response to laboratory stress in patients with CAD. Patients (n = 88) with chronic stable CAD instrumented with hemodynamic monitor, digital electrocardiogram (ECG) monitor and indwelling catheter for blood sampling completed a laboratory protocol that included initial rest (30 min), baseline (BL: 10 min), and anger recall stress (AR: 8 min). Change from BL to AR was determined for (a) parasympathetic activity (by spectral analysis of ECG); (b) sympathetic activity (by circulating catecholamines); and (c) ET-1. AR provoked increases from BL in catecholamines, and a decrease in parasympathetic activity. Multivariate analysis with change in parasympathetic activity and catecholamines, while controlling for age and use of β-blockers, revealed a significant odds ratio (OR = 3.27, 95% CI 1.03, 10.41 P = 0.04) for an increase in ET-1 associated with parasympathetic withdrawal; no other variables were significant. The predominant influence of parasympathetic activity on anger/stress-provoked increase in ET-1 is consistent with the cholinergic antiinflammatory pathway. Future examination of autonomic influences on atherosclerotic leukocytes, endothelial cell function and the dynamics of ET-1 are warranted.
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Affiliation(s)
- Matthew M Burg
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
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Abstract
Myocardial ischemia that results from emotional provocation occurs in as many as 30% to 50% of patients with coronary artery disease during the discourse of their lives. This emotionally provoked or mental stress ischemia is associated with poor prognosis, with emerging treatment strategies. This article outlines the conceptual constructs that support the pathophysiologic underpinnings, and biobehavioral aspects associated with this mental stress ischemia. We review a biobehavioral model in which cognitive stress is transduced in the brain. The response of the brain to psychosocial stress is a highly sophisticated and integrated process by which sensory inputs are evaluated and appraised for their importance in relation to previous experience and current goals. The biologic consequences of such stress transduced in the central nervous system has its effect on cardiovascular flow and function through changes in autonomic balance, which result in various biologic processes that culminate in the perturbation of flow and function of the heart.
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Affiliation(s)
- Robert Soufer
- VA Connecticut Healthcare System, Yale University School of Medicine, 950 Campbell Avenue, West Haven, CT 06516, USA.
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Lampert R, Shusterman V, Burg M, McPherson C, Batsford W, Goldberg A, Soufer R. Anger-induced T-wave alternans predicts future ventricular arrhythmias in patients with implantable cardioverter-defibrillators. J Am Coll Cardiol 2009; 53:774-8. [PMID: 19245968 DOI: 10.1016/j.jacc.2008.10.053] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Revised: 10/14/2008] [Accepted: 10/19/2008] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study sought to determine whether T-wave alternans (TWA) induced by anger in a laboratory setting predicts future ventricular arrhythmias in patients with implantable cardioverter-defibrillators (ICDs). BACKGROUND Anger can precipitate spontaneous ventricular tachycardia/ventricular fibrillation and induce TWA. Whether anger-induced TWA predicts future arrhythmias is unknown. METHODS Sixty-two patients with ICDs underwent ambulatory electrocardiography during a mental stress protocol, 3 months after the ICD was implanted. T-wave alternans was analyzed using time-domain methods. After a > or =1 year follow-up, ICD stored data was reviewed to determine incidence of ICD-terminated ventricular tachycardia/ventricular fibrillation. RESULTS Patients with ICD-terminated arrhythmias during follow-up (n = 10) had higher TWA induced by anger, 13.2 microV (interquartile range [IQR] 9.3 to 16 microV), compared with those patients without future ventricular arrhythmias, 9.3 microV (IQR 7.5 to 11.5 microV, p < 0.01). Patients in the highest quartile of anger-induced TWA (>11.9 microV, n = 15) were more likely to experience arrhythmias by 1 year than those in the lower quartiles (33% vs. 4%) and during extended follow-up (40% vs. 9%, p < 0.01 for both). In multivariable regression controlling for ejection fraction, prior clinical arrhythmia, and wide QRS, anger-induced TWA remained a significant predictor of arrhythmia, with likelihood in the top quartile 10.8 times that of other patients (95% confidence interval: 1.6 to 113, p < 0.05). CONCLUSIONS Anger-induced TWA predicts future ventricular arrhythmias in patients with ICDs, suggesting that emotion-induced repolarization instability may be 1 mechanism linking stress and sudden death. Whether there is a clinical role for anger-induced TWA testing requires further study.
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Affiliation(s)
- Rachel Lampert
- Yale University School of Medicine, New Haven, Connecticut, USA
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Shah R, Burg MM, Vashist A, Collins D, Liu J, Jadbabaie F, Graeber B, Earley C, Lampert R, Soufer R. C-reactive protein and vulnerability to mental stress-induced myocardial ischemia. Mol Med 2007. [PMID: 17380191 DOI: 10.2119/2006-00077.shah] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Myocardial ischemia provoked in the laboratory during mental stress (MSI) in patients with stable coronary artery disease (CAD) predicts subsequent clinical events. The pathophysiology of MSI differs from that of exercise ischemia, and the mechanisms tying MSI to poor prognosis are not known. C-reactive protein (CRP) is a risk marker for cardiovascular events in patients with CAD, but little is known regarding the relationship of CRP to MSI. The purpose of this study was to examine the association of CRP to risk of MSI in CAD patients. Eighty-three patients with stable CAD underwent simultaneous single-photon emission computed tomography (SPECT) imaging with technetium-99m tetrofosmin myocardial perfusion imaging (MPI) and transthoracic echocardiography (TTE), at rest and during MS induced by laboratory mental stress. Serum CRP levels were measured 24 h after MS. MSI was defined by the presence of a new perfusion defect on SPECT and/or new regional wall motion abnormality on TTE during MS. Of the 83 patients, 30 (36%) developed MSI. There was no difference in gender, sex, BMI, histories of diabetes, hypertension, smoking, lipid profile, medications used (including statins, beta-blockers, ACE inhibitors, and aspirin), or hemodynamic response during MS between those with and without MSI. In univariate logistic regression analysis, each unit (1 mg/L) increase in CRP level was associated with 20% higher risk of MSI (OR 1.2, 95% CI 1.01-1.39, P=.04). This relationship remained in multivariate models. These data suggest that levels of CRP may be a risk marker for MSI in patients with CAD.
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Affiliation(s)
- Rahman Shah
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT 06520-8017, USA
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Lampert R, Soufer R, McPherson CA, Batsford WP, Tirado S, Earley C, Goldberg A, Shusterman V. Implantable Cardioverter-Defibrillator Shocks Increase T-Wave Alternans. J Cardiovasc Electrophysiol 2007; 18:512-7. [PMID: 17428273 DOI: 10.1111/j.1540-8167.2007.00787.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION While implantable defibrillator shocks save lives, shock can lead to ventricular arrhythmias. However, the mechanism of shock-related proarrhythmia remains unclear. We evaluated the impact of ICD shock on repolarization instability, a factor associated with ventricular arrhythmogenesis. METHODS AND RESULTS Sixty-five patients with ICDs underwent ambulatory ECG monitoring during defibrillation testing 3 months postimplant. TWA was analyzed continuously in the time domain during baseline, sedated, and post-shock states. RR, QRS, and QT intervals and catecholamines were also measured continuously. Adequate pre- and post-shock Holter data were recorded in 55 patients, 48 male, mean 64 +/- 12 years, 50 with coronary disease, 48 with prior spontaneous or induced arrhythmia. TWA significantly increased after shock, from 9.6 +/- 0.5 to 11.9 +/- 0.6 microV, as did QRS duration, epinephrine, and norepinephrine levels, compared with sedated and baseline states. RR intervals decreased minimally. TWA changes with shock were not associated with RR or QRS duration changes, but were associated with changes in epinephrine. CONCLUSIONS ICD shock, even in the sedated state, increases repolarization instability as measured by TWA, an effect mediated in part by sympathetic stimulation. This association between shock and TWA may have important mechanistic and clinical implications for optimization of defibrillation therapy.
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Affiliation(s)
- Rachel Lampert
- Department of Medicine, Yale University School of Medicine New Haven, Connecticut, USA.
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Shah R, Burg MM, Vashist A, Collins D, Liu J, Jadbabaie F, Graeber B, Earley C, Lampert R, Soufer R. C-reactive protein and vulnerability to mental stress-induced myocardial ischemia. Mol Med 2007; 12:269-74. [PMID: 17380191 PMCID: PMC1829194 DOI: 10.2119/2006–00077.shah] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 09/19/2006] [Accepted: 09/20/2006] [Indexed: 11/06/2022]
Abstract
Myocardial ischemia provoked in the laboratory during mental stress (MSI) in patients with stable coronary artery disease (CAD) predicts subsequent clinical events. The pathophysiology of MSI differs from that of exercise ischemia, and the mechanisms tying MSI to poor prognosis are not known. C-reactive protein (CRP) is a risk marker for cardiovascular events in patients with CAD, but little is known regarding the relationship of CRP to MSI. The purpose of this study was to examine the association of CRP to risk of MSI in CAD patients. Eighty-three patients with stable CAD underwent simultaneous single-photon emission computed tomography (SPECT) imaging with technetium-99m tetrofosmin myocardial perfusion imaging (MPI) and transthoracic echocardiography (TTE), at rest and during MS induced by laboratory mental stress. Serum CRP levels were measured 24 h after MS. MSI was defined by the presence of a new perfusion defect on SPECT and/or new regional wall motion abnormality on TTE during MS. Of the 83 patients, 30 (36%) developed MSI. There was no difference in gender, sex, BMI, histories of diabetes, hypertension, smoking, lipid profile, medications used (including statins, beta-blockers, ACE inhibitors, and aspirin), or hemodynamic response during MS between those with and without MSI. In univariate logistic regression analysis, each unit (1 mg/L) increase in CRP level was associated with 20% higher risk of MSI (OR 1.2, 95% CI 1.01-1.39, P=.04). This relationship remained in multivariate models. These data suggest that levels of CRP may be a risk marker for MSI in patients with CAD.
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Affiliation(s)
- Rahman Shah
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
- VA Connecticut Healthcare System, West Haven Campus, West Haven, CT, USA
| | - Matthew M Burg
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
- VA Connecticut Healthcare System, West Haven Campus, West Haven, CT, USA
- Columbia University School of Medicine, New York City, NY, USA
| | - Aseem Vashist
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
- VA Connecticut Healthcare System, West Haven Campus, West Haven, CT, USA
| | - Dorothea Collins
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
- VA Connecticut Healthcare System, West Haven Campus, West Haven, CT, USA
| | - Joyce Liu
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
- VA Connecticut Healthcare System, West Haven Campus, West Haven, CT, USA
| | - Farid Jadbabaie
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
- VA Connecticut Healthcare System, West Haven Campus, West Haven, CT, USA
| | - Brendon Graeber
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Christine Earley
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
- VA Connecticut Healthcare System, West Haven Campus, West Haven, CT, USA
| | - Rachel Lampert
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Robert Soufer
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
- VA Connecticut Healthcare System, West Haven Campus, West Haven, CT, USA
- Address correspondence and reprint requests to Robert Soufer, Section of Cardiovascular Medicine, Yale University School of Medicine, 333 Cedar St, 3 FMP, PO Box 208017, New Haven, CT 06520-8017. Phone: 203/785-7000; Fax: 203/785-7144; E-mail
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Soufer R, Burg MM. The heart-brain interaction during emotionally provoked myocardial ischemia: implications of cortical hyperactivation in CAD and gender interactions. Cleve Clin J Med 2007; 74 Suppl 1:S59-62. [PMID: 17455547 DOI: 10.3949/ccjm.74.suppl_1.s59] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Mental and emotional stress can provoke transient ischemia and acute coronary syndrome in vulnerable patients. Furthermore, those patients so provoked are at increased risk for recurrent cardiac events and early death. Viable psychological treatments to improve prognosis exist, and preliminary trials demonstrate their efficacy with regard to short- and long-term outcomes, as well as economic savings. These findings heighten the need for efforts directed toward the complete identification of the differential pathophysiology of mental stress-induced ischemia, with an eye toward development of diagnostic tests and establishment of risk stratification algorithms that can be applied in the clinical setting. Ongoing research in this vein is identifying unique aspects of the brain-heart relationship during mental stress that underlie the cognitive and emotional aspects of mental stress, and the "dow nwind" pathways by which distinct patterns of brain activity during mental stress can provoke otherwise silent myocardial ischemia. This research is making important contributions to the larger clinical goals associated with diagnostic testing, risk stratification, and treatment of patients at risk for mental stress-induced ischemia and poorer prognosis.
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Affiliation(s)
- Robert Soufer
- Division of Cardiovascular Medicine, Yale University, New Haven, CT, USA.
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Horti A, Redmond DE, Soufer R. No-carrier-added (NCA) synthesis of 6-[18F]fluoro-L-DOPA using 3,5,6,7,8,8a-hexahydro-7,7,8a-trimethyl-[6s-(6α,8α,8αβ)]-6,8-methano-2H-1,4-benzoxazin-2-one. J Labelled Comp Radiopharm 2006. [DOI: 10.1002/jlcr.2580360503] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Affiliation(s)
- Matthew M Burg
- VA Connecticut Healthcare System, West Haven Campus, West Haven, CT, USA
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Abidov A, Hachamovitch R, Friedman JD, Hayes SW, Kang X, Cohen I, Germano G, Berman DS, Kjaer A, Cortsen A, Federspiel M, Hesse B, Holm S, O’Connor M, Dhalla AK, Wong MY, Wang WQ, Belardinelli L, Therapeutics CV, Epps A, Dave S, Brewer K, Chiaramida S, Gordon L, Hendrix GH, Feng B, Pretorius PH, Bruyant PP, Boening G, Beach RD, Gifford HC, King MA, Fessler JA, Hsu BL, Case JA, Gegen LL, Hertenstein GK, Cullom SJ, Bateman TM, Akincioglu C, Abidov A, Nishina H, Kavanagh P, Kang X, Aboul-Enein F, Yang L, Hayes S, Friedman J, Berman D, Germano G, Santana CA, Rivero A, Folks RD, Grossman GB, Cooke CD, Hunsche A, Faber TL, Halkar R, Garcia EV, Hansen CL, Silver S, Kaplan A, Rasalingam R, Awar M, Shirato S, Reist K, Htay T, Mehta D, Cho JH, Heo J, Dubovsky E, Calnon DA, Grewal KS, George PB, Richards DR, Hsi DH, Singh N, Meszaros Z, Thomas JL, Reyes E, Loong CY, Latus K, Anagnostopoulos C, Underwood SR, Kostacos EJ, Araujo LI, Kostacos EJ, Araujo LI, Lewin HC, Hyun MC, DePuey EG, Tanaka H, Chikamori T, Igarashi Y, Harafuji K, Usui Y, Yanagisawa H, Hida S, Yamashina A, Nasr HA, Mahmoud SA, Dalipaj MM, Golanowski LN, Kemp RAD, Chow BJ, Beanlands RS, Ruddy TD, Michelena HI, Mikolich BM, McNelis P, Decker WAV, Stathopoulos I, Duncan SA, Isasi C, Travin MI, Kritzman JN, Ficaro EP, Corbett JR, Allison JS, Weinsaft JW, Wong FJ, Szulc M, Okin PM, Kligfield P, Harafuji K, Chikamori T, Igarashi Y, Tanaka H, Usui Y, Yanagisawa H, Hida S, Ishimaru S, Yamashima A, Giedd KN, Bergmann SR, Shah S, Emmett L, Allman KC, Magee M, Van Gaal W, Kritharides L, Freedman B, Abidov A, Gerlach J, Akincioglu C, Friedman J, Kavanagh P, Miranda R, Germano G, Berman DS, Hayes SW, Damera N, Lone B, Singh R, Shah A, Yeturi S, Prasad Y, Blum S, Heller EN, Bhalodkar NC, Koutelou M, Kollaros N, Theodorakos A, Manginas A, Leontiadis E, Kouzoumi A, Cokkinos D, Mazzanti M, Marini M, Cianci G, Perna GP, Pai M, Greenberg MD, Liu F, Frankenberger O, Kokkinos P, Hanumara D, Goheen E, Wu C, Panagiotakos D, Fletcher R, Greenberg MD, Liu F, Frankenberger O, Kokkinos P, Hanumara D, Goheen E, Rodriguez OJ, Iyer VN, Lue M, Hickey KT, Blood DK, Bergmann SR, Bokhari S, Chareonthaitawee P, Christensen SD, Allen JL, Kemp BJ, Hodge DO, Ritman EL, Gibbons RJ, Smanio P, Riva G, Rodriquez F, Tricoti A, Nakhlawi A, Thom A, Pretorius PH, King MA, Dahlberg S, Leppo J, Slomka PJ, Nishina H, Berman DS, Akincioglu C, Abidov A, Friedman JD, Hayes SW, Germano G, Petrovici R, Husain M, Lee DS, Nanthakumar K, Iwanochko RM, Brunken RC, DiFilippo F, Neumann DR, Bybel B, Herrington B, Bruckbauer T, Howe C, Lohmann K, Hayden C, Chatterjee C, Lathrop B, Brunken RC, Chen MS, Lohmann KA, Howe WC, Bruckbauer T, Kaczur T, Bybel B, DiFilippo FP, Druz RS, Akinboboye OA, Grimson R, Nichols KJ, Reichek N, Ngai K, Dim R, Ho KT, Pary S, Ahmed SU, Ahlberg A, Cyr G, Vitols PJ, Mann A, Alexander L, Rosenblatt J, Mieres J, Heller GV, Ahmed SU, Ahlberg AW, Cyr G, Navare S, O’Sullivan D, Heller GV, Chiadika S, Lue M, Blood DK, Bergmann SR, Bokhari S, Heston TF, Heller GV, Cerqueira MD, Jones PG, Bryngelson JR, Moutray KL, Gegen LL, Hertenstein GK, Moser K, Case JA, Zellweger MJ, Burger PC, Pfisterer ME, Mueller-Brand J, Kang WJ, Lee BI, Lee DS, Paeng JC, Lee JS, Chung JK, Lee MC, To BN, O’Connell WJ, Botvinick EH, Duvall WL, Croft LB, Einstein AJ, Fisher JE, Haynes PS, Rose RK, Henzlova MJ, Prasad Y, Vashist A, Blum S, Sagar P, Heller EN, Kuwabara Y, Nakayama K, Tsuru Y, Nakaya J, Shindo S, Hasegawa M, Komuro I, Liu YH, Wackers F, Natale D, DePuey G, Taillefer R, Araujo L, Kostacos E, Allen S, Delbeke D, Anstett F, Kansal P, Calvin JE, Hendel RC, Gulati M, Pratap P, Takalkar A, Kostacos E, Alavi A, Araujo L, Melduni RM, Duncan SA, Travin MI, Isasi CR, Rivero A, Santana C, Esiashvili S, Grossman G, Halkar R, Folks RD, Garcia EV, Su H, Dobrucki LW, Chow C, Hu X, Bourke BN, Cavaliere P, Hua J, Sinusas AJ, Spinale FG, Sweterlitsch S, Azure M, Edwards DS, Sudhakar S, Chyun DA, Young LH, Inzucchi SE, Davey JA, Wackers FJ, Noble GL, Navare SM, Calvert J, Hussain SA, Ahlberg AM, Katten DM, Boden WE, Heller GV, Shaw LJ, Yang Y, Antunes A, Botelho MF, Gomes C, de Lima JJP, Silva ML, Moreira JN, Simões S, GonÇalves L, Providência LA, Elhendy A, Bax JJ, Schinkel AF, Valkema R, van Domburg RT, Poldermans D, Arrighi J, Lampert R, Burg M, Soufer R, Veress AI, Weiss JA, Huesman RH, Gullberg GT, Moser K, Case JA, Loong CY, Prvulovich EM, Reyes E, Aswegen AV, Anagnostopoulos C, Underwood SR, Htay T, Mehta D, Sun L, Lacy J, Heo J, Brunken RC, Kaczur T, Jaber W, Ramakrishna G, Miller TD, O’connor MK, Gibbons RJ, Bural GG, Mavi A, Kumar R, El-Haddad G, Srinivas SM, A Alavi, El-Haddad G, Alavi A, Araujo L, Thomas GS, Johnson CM, Miyamoto MI, Thomas JJ, Majmundar H, Ryals LA, Ip ZTK, Shaw LJ, Bishop HA, Carmody JP, Greathouse WG, Yanagisawa H, Chikamori T, Tanaka H, Usui Y, Igarashi U, Hida S, Morishima T, Tanaka N, Takazawa K, Yamashina A, Diedrichs H, Weber M, Koulousakis A, Voth E, Schwinger RHG, Mohan HK, Livieratos L, Gallagher S, Bailey DL, Chambers J, Fogelman I, Sobol I, Barst RJ, Nichols K, Widlitz A, Horn E, Bergmann SR, Chen J, Galt JR, Durbin MK, Ye J, Shao L, Garcia EV, Mahenthiran J, Elliott JC, Jacob S, Stricker S, Kalaria VG, Sawada S, Scott JA, Aziz K, Yasuda T, Gewirtz H, Hsu BL, Moutray K, Udelson JE, Barrett RJ, Johnson JR, Menenghetti C, Taillefer R, Ruddy T, Hachamovitch R, Jenkins SA, Massaro J, Haught H, Lim CS, Underwood R, Rosman J, Hanon S, Shapiro M, Schweitzer P, VanTosh A, Jones S, Harafuji K, Giedd KN, Johnson NP, Berliner JI, Sciacca RR, Chou RL, Hickey KT, Bokhari SS, Rodriguez O, Bokhari S, Moser KW, Moutray KL, Koutelou M, Theodorakos A, Kollaros N, Manginas A, Leontiadis E, Cokkinos D, Mazzanti M, Marini M, Cianci G, Perna GP, Nanasato M, Fujita H, Toba M, Nishimura T, Nikpour M, Urowitz M, Gladman D, Ibanez D, Harvey P, Floras J, Rouleau J, Iwanochko R, Pai M, Guglin ME, Ginsberg FL, Reinig M, Parrillo JE, Cha R, Merhige ME, Watson GM, Oliverio JG, Shelton V, Frank SN, Perna AF, Ferreira MJ, Ferrer-Antunes AI, Rodrigues V, Santos F, Lima J, Cerqueira MD, Magram MY, Lodge MA, Babich JW, Dilsizian V, Line BR, Bhalodkar NC, Lone B, Singh R, Prasad Y, Yeturi S, Blum S, Heller EN, Rodriguez OJ, Skerrett D, Charles C, Shuster MD, Itescu S, Wang TS, Bruyant PP, Pretorius PH, Dahlberg S, King MA, Petrovici R, Iwanochko RM, Lee DS, Emmett L, Husain M, Hosokawa R, Ohba M, Kambara N, Tadamura E, Kubo S, Nohara R, Kita T, Thompson RC, McGhie AI, O’Keefe JH, Christenson SD, Chareonthaitawee P, Kemp BJ, Jerome S, Russell TJ, Lowry DR, Coombs VJ, Moses A, Gottlieb SO, Heiba SI, Yee G, Coppola J, Elmquist T, Braff R, Youssef I, Ambrose JA, Abdel-Dayem HM, Canto J, Dubovsky E, Scott J, Terndrup TE, Faber TL, Folks RD, Dim UR, Mclaughlin J, Pollepalle D, Schapiro W, Wang Y, Akinboboye O, Ngai K, Druz RS, Polepalle D, Phippen-Nater B, Leonardis J, Druz R. Abstracts of original contributions ASNC 2004 9th annual scientific session September 3-–October 3, 2004 New York, New York. J Nucl Cardiol 2004. [DOI: 10.1007/bf02974964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lampert R, Shusterman V, Burg MM, Lee FA, Earley C, Goldberg A, McPherson CA, Batsford WP, Soufer R. 1148-208 Psychological stress increases heterogeneity of repolarization in patients with structural heart disease and ventricular arrhythmias. J Am Coll Cardiol 2004. [DOI: 10.1016/s0735-1097(04)90595-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
OBJECTIVES Depression has been related to mortality in patients with CAD and to medical morbidity after CABG; however, prior studies have not examined the contribution of presurgical depressive symptoms to mortality after CABG. The purpose of this study was to determine the independent contribution of presurgical symptoms of depression to 2-year cardiac mortality after CABG. METHODS Eighty-nine consecutive veteran nonemergent CABG patients recruited between December 1996 and June 1998 completed the BDI 1 to 7 days before surgery. Mortality risk was assessed by medical co-morbidity and RIS. RESULTS Significant univariate contributions to two-year cardiovascular mortality were found for RIS (chi2 = 6.57, p <.01), history of CHF (chi2 = 4.94, p <.02), history of COPD (chi2 = 5.19, p <.02), and elevated depressive symptoms (chi2 = 4.70, p <.03). The multivariate model revealed that the RIS (chi2 = 4.70, p <.03) and elevated depressive symptoms (chi2 = 3.86, p <.05) remained significant in the prediction of 2-year cardiovascular mortality, with no other variables being found significant. CONCLUSIONS Elevated depressive symptoms before CABG surgery appear to be an important independent contributor to long-term mortality. Future research should focus on replication with larger, more diverse samples, and identification of pathophysiological mechanisms.
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Affiliation(s)
- Matthew M Burg
- Veterans Affairs Connecticut Healthcare System, West Haven Campus, West Haven, Connecticut 06516, USA.
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Bremner JD, Vythilingam M, Vermetten E, Southwick SM, McGlashan T, Staib LH, Soufer R, Charney DS. Neural correlates of declarative memory for emotionally valenced words in women with posttraumatic stress disorder related to early childhood sexual abuse. Biol Psychiatry 2003; 53:879-89. [PMID: 12742675 DOI: 10.1016/s0006-3223(02)01891-7] [Citation(s) in RCA: 221] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Animal studies have shown that early stressors result in lasting changes in structure and function of brain areas involved in memory, including hippocampus and frontal cortex. Patients with childhood abuse-related posttraumatic stress disorder (PTSD) have alterations in both declarative and nondeclarative memory function, and imaging studies in PTSD have demonstrated changes in function during stimulation of trauma-specific memories in hippocampus, medial prefrontal cortex, and cingulate. The purpose of this study was to assess neural correlates of emotionally valenced declarative memory in women with early childhood sexual abuse and PTSD. METHODS Women with early childhood sexual abuse-related PTSD (n = 10) and women without abuse or PTSD (n = 11) underwent positron emission tomographic (PET) measurement of cerebral blood flow during a control condition and during retrieval of neutral (e.g., "metal-iron") and emotionally valenced (e.g., "rape-mutilate") word pairs. RESULTS During retrieval of emotionally valenced word pairs, PTSD patients showed greater decreases in blood flow in an extensive area, which included orbitofrontal cortex, anterior cingulate, and medial prefrontal cortex (Brodmann's areas 25, 32, 9), left hippocampus, and fusiform gyrus/inferior temporal gyrus, with increased activation in posterior cingulate, left inferior parietal cortex, left middle frontal gyrus, and visual association and motor cortex. There were no differences in patterns of brain activation during retrieval of neutral word pairs between patients and control subjects. CONCLUSIONS These findings are consistent with dysfunction of specific brain areas involved in memory and emotion in PTSD. Regions implicated in this study of emotionally valenced declarative memory are similar to those from prior imaging studies in PTSD using trauma-specific stimuli for symptom provocation, adding further supportive evidence for a dysfunctional network of brain areas involved in memory, including hippocampus, medial prefrontal cortex, and cingulate, in PTSD.
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Affiliation(s)
- J Douglas Bremner
- Department of Psychiatry and Behavioral Sciences, Emory Center for Positron Emission Tomography, Emory University School of Medicine, Atlanta, Georgia 30306, USA
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Arrighi JA, Burg M, Cohen IS, Soufer R. Simultaneous assessment of myocardial perfusion and function during mental stress in patients with chronic coronary artery disease. J Nucl Cardiol 2003; 10:267-74. [PMID: 12794625 DOI: 10.1016/s1071-3581(02)43235-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Mental stress (MS) is an important provocateur of myocardial ischemia in many patients with chronic coronary artery disease. The majority of laboratory assessments of ischemia in response to MS have included measurements of either myocardial perfusion or function alone. We performed this study to determine the relationship between alterations in perfusion and ventricular function during MS. Methods and results Twenty-eight patients with reversible perfusion defects on exercise or pharmacologic stress myocardial perfusion imaging (MPI) underwent simultaneous technetium 99m sestamibi single photon emission computed tomography (SPECT) MPI and transthoracic echocardiography at rest and during MS according to a mental arithmetic protocol. In all cases the MS study was performed within 4 weeks of the initial exercise or pharmacologic MPI that demonstrated ischemia. SPECT studies were analyzed visually with the use of a 13-segment model and quantitatively by semiautomated circumferential profile analysis. Echocardiograms were graded on a segmental model for regional wall motion on a 4-point scale. Of 28 patients, 18 (64%) had perfusion defects and/or left ventricular dysfunction develop during MS: 9 (32%) had myocardial perfusion defects develop, 6 (21%) had regional or global left ventricular dysfunction develop, and 3 (11%) had both perfusion defects and left ventricular dysfunction develop. The overall concordance between perfusion and function criteria for ischemia during MS was only 46%. Among 9 patients with MS-induced left ventricular dysfunction, 5 had new regional wall motion abnormalities and 4 had a global decrement in function. In patients with MS-induced ischemia by SPECT, the number of reversible perfusion defects was similar during both MS and exercise/pharmacologic stress (2.8 +/- 2.0 vs 3.5 +/- 1.8, P =.41). Hemodynamic changes during MS were similar whether patients were divided on the basis of perfusion defects or left ventricular dysfunction during MS. CONCLUSIONS These data indicate the feasibility of simultaneous assessment of perfusion and function responses during MS. Flow and function responses to MS are frequently not concordant. These data suggest that MS-induced changes in perfusion may represent a different phenomenon than MS-induced changes in left ventricular function (either globally or regionally).
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Affiliation(s)
- James A Arrighi
- Section of Cardiovascular Medicine, Deparment of Medicine, Yale University School of Medicine, New Haven, CT 06516, USA.
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Bremner JD, Vythilingam M, Vermetten E, Southwick SM, McGlashan T, Nazeer A, Khan S, Vaccarino LV, Soufer R, Garg PK, Ng CK, Staib LH, Duncan JS, Charney DS. MRI and PET study of deficits in hippocampal structure and function in women with childhood sexual abuse and posttraumatic stress disorder. Am J Psychiatry 2003; 160:924-32. [PMID: 12727697 DOI: 10.1176/appi.ajp.160.5.924] [Citation(s) in RCA: 423] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Animal studies have suggested that early stress is associated with alterations in the hippocampus, a brain area that plays a critical role in learning and memory. The purpose of this study was to measure both hippocampal structure and function in women with and without early childhood sexual abuse and the diagnosis of posttraumatic stress disorder (PTSD). METHOD Thirty-three women participated in this study, including women with early childhood sexual abuse and PTSD (N=10), women with abuse without PTSD (N=12), and women without abuse or PTSD (N=11). Hippocampal volume was measured with magnetic resonance imaging in all subjects, and hippocampal function during the performance of hippocampal-based verbal declarative memory tasks was measured by using positron emission tomography in abused women with and without PTSD. RESULTS A failure of hippocampal activation and 16% smaller volume of the hippocampus were seen in women with abuse and PTSD compared to women with abuse without PTSD. Women with abuse and PTSD had a 19% smaller hippocampal volume relative to women without abuse or PTSD. CONCLUSIONS These results are consistent with deficits in hippocampal function and structure in abuse-related PTSD.
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Affiliation(s)
- J Douglas Bremner
- Department of Psychiatry and Behavioral Sciences, Emory Clinical Neuroscience Research Unit, Emory University School of Medicine, 1256 Briarcliff Road, Atlanta, GA 30306, USA.
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Abstract
OBJECTIVE Depression has been related to poor medical prognosis in patients with coronary artery disease and to diminished quality of life after coronary artery bypass graft surgery (CABG). However, prior studies have not fully examined the impact of depression on medical outcomes after CABG. The purpose of this study was to determine the independent contribution of presurgical depression to short-term medical outcome after CABG. METHODS Medical, surgical, and psychosocial risk factors were assessed before surgery in 89 male veterans undergoing CABG. In addition, patients completed the Beck Depression Inventory. Medical, surgical, and psychological/quality-of-life outcomes were determined at 6 months of follow-up by telephone interview and review of medical records. RESULTS Of the 89 patients studied, 25 scored 10 or greater on the Beck Depression Inventory. The study population was dichotomized on the basis of this cutoff point. A medical prediction model was developed for each outcome of interest, based on the range of medical, surgical, and psychosocial risk indices assessed. The dichotomized depression index was added to these prediction models as a final step. This depression index was found to independently predict cardiac hospitalizations at 6 months (chi(2) = 4.24, p <.04), continued surgical pain at 6 months (chi(2) = 6.36, p <.01), and failure to return to previous activity at 6 months (chi(2) = 15.04, p <.0001). Presurgical depression also predicted depressed affect at 6 months (chi(2) = 13.16, p <.0003). CONCLUSIONS Depression is an important independent contributor to medical and psychosocial morbidity up to 6 months after CABG. These findings warrant replication with larger and more diverse populations.
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Affiliation(s)
- Matthew M Burg
- VA Connecticut Healthcare System, West Haven Campus, West Haven, CT 06516, USA.
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Bremner JD, Soufer R, McCarthy G, Delaney R, Staib LH, Duncan JS, Charney DS. Gender differences in cognitive and neural correlates of remembrance of emotional words. Psychopharmacol Bull 2002; 35:55-78. [PMID: 12397879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Studies suggest that men and women have important differences in specific cognitive functions. Men show superior spatial memory and women demonstrate superior verbal memory, and women rely on emotional content to a greater degree in the processing of information. In spite of extensive research in neural correlates of human cognition, little is known about possible gender differences or the role of emotional content in the mediation of cognition. Two sets of lists of word pairs were developed, one with neutral (e.g., school-grocery) and the other with emotional (e.g., mutilate-beat) content. Male and female subjects were asked to rate emotions related to the words on several dimensions (e.g., nervous, fearful, happy). In a second experiment, men and women underwent positron emission tomographic (PET) measurement of brain blood flow during retrieval of word pairs. Words in the "emotional" category were rated more highly on the emotional dimensions, and women rated them as having more emotional impact than did the men. During retrieval of emotional words (but not neutral words) there was a different pattern of activation among the women compared with the men, with greater activation in bilateral posterior hippocampus and cerebellum, and decreased activity in medial prefrontal cortex, which are brain areas previously implicated in emotion. There were no significant differences in retrieval of emotional versus neutral words, or in differences in memory performance between men and women. The findings suggest differences in cognitive appraisal and involvement of a broader network of brain regions mediating emotion during remembrance of emotional words in women compared with men.
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Affiliation(s)
- J D Bremner
- Departments of Psychiatry and Behavioral Sciences and Radiology, Emory Center for Positron Emission Tomography, Emory University School of Medicine, Atlanta, GA, USA.
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Affiliation(s)
- Robert Soufer
- Section of Cardiovascular Medicine, VA Connecticut Healthcare System, Yale University School of Medicine, West Haven, CT 06516, USA.
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Shi CQ, Young LH, Daher E, DiBella EVR, Liu YH, Heller EN, Zoghbi S, Wackers FJT, Soufer R, Sinusas AJ. Correlation of myocardial p-(123)I-iodophenylpentadecanoic acid retention with (18)F-FDG accumulation during experimental low-flow ischemia. J Nucl Med 2002; 43:421-31. [PMID: 11884504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
UNLABELLED Myocardial ischemia is associated with reduced free fatty acid (FFA) beta-oxidation and increased glucose utilization. This study evaluated the potential of dynamic SPECT imaging of a FFA analog, p-(123)I-iodophenylpentadecanoic acid (IPPA), for detection of ischemia and compares retention of IPPA with (18)F-FDG accumulation. METHODS In a canine model of regional low-flow ischemia (n = 9), serial IPPA SPECT images (2 min per image) were acquired over 52--90 min. In a subset of dogs (n = 6), (18)F-FDG was injected after completing SPECT imaging and allowed to accumulate for 40 min before killing the animals. Flow was assessed with radiolabeled microspheres. Myocardial metabolism was evaluated independently by selective coronary arterial and venous sampling. RESULTS Serial IPPA SPECT images showed an initial defect in the ischemic region (0.70% plus minus 0.03% ischemic-to-nonischemic ratio), which normalized within 48 min because of the slower IPPA clearance from the ischemic region (t(1/2) = 54.2 plus minus 3.3 min) relative to the nonischemic region (t(1/2) = 36.7 plus minus 5.6 min) (P < 0.05). Delayed myocardial IPPA and (18)F-FDG activities were correlated (r = 0.70; n = 576 segments), and both were maximally increased in segments with a moderate flow reduction (IPPA, 151% of nonischemic; (18)F-FDG, 450% of nonischemic; P < 0.05). CONCLUSION Serial SPECT imaging showed delayed myocardial clearance of IPPA in ischemic regions with moderate flow reduction, which lead to increased late myocardial retention of IPPA. Retention of IPPA correlated with (18)F-FDG accumulation, supporting the potential of IPPA as a noninvasive marker of ischemic myocardium.
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Affiliation(s)
- Cindy Q Shi
- Experimental Nuclear Cardiology Laboratory, Division of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut 06520-8017, USA
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Soares JC, van Dyck CH, Tan P, Zoghbi SS, Garg P, Soufer R, Baldwin RM, Fujita M, Staley JK, Fu X, Amici L, Seibyl J, Innis RB. Reproducibility of in vivo brain measures of 5-HT2A receptors with PET and. Psychiatry Res 2001; 106:81-93. [PMID: 11306248 DOI: 10.1016/s0925-4927(01)00071-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The test/retest reproducibility of brain measures of 5-HT2A receptors with positron emission tomography (PET) and [18F]deuteroaltanserin was examined in a group of eight healthy human subjects. PET measures of 5-HT2A receptors were obtained under an equilibrium paradigm, with a 40-min PET acquisition starting approximately at 300 min (308+/-11 min) after bolus plus constant infusion of the radiotracer. Three brain outcome measures were obtained at equilibrium, V(3) (ratio of specific brain uptake to free parent plasma concentration of radiotracer), V(3)' (ratio of specific brain uptake to total parent plasma concentration) and RT (ratio of specific to non-displaceable brain uptakes). V(3)' and RT had high test/retest reproducibility, as measured by mean intra-subject% change for cortical brain areas of 14.1 and 11.0%, respectively. They also had high reliability, as measured by mean intra-class correlation coefficients (ICC) for cortical brain areas of 0.86 and 0.88, respectively. V(3) had low test/retest reproducibility, due to high variability in the measures of free parent tracer in plasma. This study supports the feasibility of equilibrium imaging of 5-HT2A receptors with PET and [18F]deuteroaltanserin. The equilibrium imaging method with [18F]deuteroaltanserin allows a single acquisition and blood measurement to provide an image whose pixel values equal a receptor volume of distribution. Since the single image pixel values are proportional to receptor densities, the images can be used in pixel-by-pixel statistical methods, such as SPM, to assess the distribution and density of 5-HT2A receptors in neuropsychiatric disorders.
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Affiliation(s)
- J C Soares
- Department of Psychiatry, Yale University School of Medicine, VA Connecticut Healthcare System, West Haven, CT 06516, USA
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Staley JK, Van Dyck CH, Tan PZ, Al Tikriti M, Ramsby Q, Klump H, Ng C, Garg P, Soufer R, Baldwin RM, Innis RB. Comparison of [(18)F]altanserin and [(18)F]deuteroaltanserin for PET imaging of serotonin(2A) receptors in baboon brain: pharmacological studies. Nucl Med Biol 2001; 28:271-9. [PMID: 11323237 DOI: 10.1016/s0969-8051(00)00212-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The regional distribution in brain, distribution volumes, and pharmacological specificity of the PET 5-HT(2A) receptor radiotracer [(18)F]deuteroaltanserin were evaluated and compared to those of its non-deuterated derivative [(18)F]altanserin. Both radiotracers were administered to baboons by bolus plus constant infusion and PET images were acquired up to 8 h. The time-activity curves for both tracers stabilized between 4 and 6 h. The ratio of total and free parent to metabolites was not significantly different between radiotracers; nevertheless, total cortical R(T) (equilibrium ratio of specific to nondisplaceable brain uptake) was significantly higher (34-78%) for [(18)F]deuteroaltanserin than for [(18)F]altanserin. In contrast, the binding potential (Bmax/K(D)) was similar between radiotracers. [(18)F]Deuteroaltanserin cortical activity was displaced by the 5-HT(2A) receptor antagonist SR 46349B but was not altered by changes in endogenous 5-HT induced by fenfluramine. These findings suggest that [(18)F]deuteroaltanserin is essentially equivalent to [(18)F]altanserin for 5-HT(2A) receptor imaging in the baboon.
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Affiliation(s)
- J K Staley
- Department of Psychiatry, Yale University School of Medicine and VA Connecticut Healthcare System, 06516, West Haven, CT 06516, USA.
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Arrighi JA, Burg M, Cohen IS, Kao AH, Pfau S, Caulin-Glaser T, Zaret BL, Soufer R. Myocardial blood-flow response during mental stress in patients with coronary artery disease. Lancet 2000; 356:310-1. [PMID: 11071190 DOI: 10.1016/s0140-6736(00)02510-1] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Positron emission tomography was used to quantify changes in myocardial blood flow during mental stress in patients with and without coronary artery disease. Blunted augmentation of myocardial blood flow during mental stress was observed in regions without significant epicardial stenosis.
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McNulty PH, Jagasia D, Cline GW, Ng CK, Whiting JM, Garg P, Shulman GI, Soufer R. Persistent changes in myocardial glucose metabolism in vivo during reperfusion of a limited-duration coronary occlusion. Circulation 2000; 101:917-22. [PMID: 10694532 DOI: 10.1161/01.cir.101.8.917] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Rapid reperfusion of an occluded coronary artery salvages regional mechanical function, but this benefit may not be realized for hours or days because of postischemic stunning. Recovery from stunning is incompletely understood but may involve adaptive changes in heart glucose metabolism. METHODS AND RESULTS To examine whether reversible coronary occlusion produces sustained changes in regional glucose metabolism in vivo, we performed a 20-minute left coronary artery occlusion followed by 24 hours of open-artery reperfusion in intact rats. Coronary occlusion produced stunning of the anterolateral left ventricle that resolved over 24 hours. When examined at 24 hours, reperfused regions were fully contractile and viable by vital staining and microscopy but demonstrated 25% reduction in blood flow and 50% increased uptake of circulating glucose, as estimated by in vivo [(13)N]NH(3) and [(18)F]fluorodeoxyglucose (FDG) tracer uptake. Reperfused regions had largely inactive glycogen synthase, low rates of glycogen synthesis, and persistent 50% glycogen depletion but increased flux of plasma [1-(13)C]glucose into myocardial [3-(13)C]alanine, indicating preferential shunting of imported glucose away from storage and into glycolysis. CONCLUSIONS Sustained increases in regional glycolytic consumption of circulating glucose occur during reperfusion of a limited-duration coronary occlusion. This suggests a role for glycolytic ATP in the recovery from postischemic stunning in vivo. Furthermore, [(13)N]NH(3) /FDG regional mismatch may constitute a clinically accessible late metabolic signature of regional myocardial ischemia.
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Affiliation(s)
- P H McNulty
- Sections of Cardiovascular Medicine, Connecticut VA Medical Center, Yale University School of Medicine, New Haven, CT 06510, USA
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van Dyck CH, Tan PZ, Baldwin RM, Amici LA, Garg PK, Ng CK, Soufer R, Charney DS, Innis RB. PET quantification of 5-HT2A receptors in the human brain: a constant infusion paradigm with [18F]altanserin. J Nucl Med 2000; 41:234-41. [PMID: 10688105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
UNLABELLED [18F]altanserin has been used to label serotonin 5-HT2A receptors, which are believed to be important in the pathophysiology of schizophrenia and depression. The purpose of this study was to test the feasibility of a constant infusion paradigm for equilibrium modeling of [18F]altanserin with PET. Kinetic modeling with [18F]altanserin may be hampered by the presence of lipophilic radiometabolites observed in plasma after intravenous administration. METHODS Eight healthy volunteers were injected with [18F]altanserin as a bolus (208+/-9 MBq [5.62+/-0.25 mCi]) plus constant infusion (65+/-3 MBq/h [1.76+/-0.08 mCi/h]) ranging from 555 to 626 min (615+/-24 min) after injection. PET acquisitions (10-20 min) and venous blood sampling were performed every 30-60 min throughout the infusion period. RESULTS Linear regression analysis revealed that time-activity curves for both brain activity and plasma [18F]altanserin and metabolite concentrations stabilized after about 6 h. This permitted equilibrium modeling and estimation of V3' (ratio of specific uptake [cortical-cerebellar] to total plasma parent concentration after 6 h). Values of V3' ranged from 1.57+/-0.38 for anterior cingulate cortex to 1.02+/-0.39 for frontal cortex. The binding potential V3 (ratio of specific uptake to free plasma parent concentration after 6 h, using group mean f1) was also calculated and ranged from 169+/-41 for anterior cingulate cortex to 110+/-42 for frontal cortex. From 6 h onward, the rate of change for V3' and V3 was only 1.11+/-1.69 %/h. CONCLUSION These results demonstrate the feasibility of equilibrium imaging with [18F]altanserin over more than 5 radioactive half-lives and suggest a method to overcome difficulties associated with lipophilic radiolabeled metabolites. The stability in V3 and V3' once equilibrium is achieved suggests that a single PET acquisition obtained at 6 h may provide a reasonable measure of 5-HT2A receptor density.
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Affiliation(s)
- C H van Dyck
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut 06510, USA
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Bremner JD, Horti A, Staib LH, Zea-Ponce Y, Soufer R, Charney DS, Baldwin R. Kinetic modeling of benzodiazepine receptor binding with PET and high specific activity [(11)C]Iomazenil in healthy human subjects. Synapse 2000; 35:68-77. [PMID: 10579810 DOI: 10.1002/(sici)1098-2396(200001)35:1<68::aid-syn9>3.0.co;2-h] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Quantitation of the PET benzodiazepine receptor antagonist, [(11)C]Iomazenil, using low specific activity radioligand was recently described. The purpose of this study was to quantitate benzodiazepine receptor binding in human subjects using PET and high specific activity [(11)C]Iomazenil. Six healthy human subjects underwent PET imaging following a bolus injection of high specific activity (>100 Ci/mmol) [(11)C]iomazenil. Arterial samples were collected at multiple time points after injection for measurement of unmetabolized total and nonprotein-bound parent compound in plasma. Time activity curves of radioligand concentration in brain and plasma were analyzed using two and three compartment model. Kinetic rate constants of transfer of radioligand between plasma, nonspecifically bound brain tissue, and specifically bound brain tissue compartments were fitted to the model. Values for fitted kinetic rate constants were used in the calculation of measures of benzodiazepine receptor binding, including binding potential (the ratio of receptor density to affinity), and product of BP and the fraction of free nonprotein-bound parent compound (V(3)'). Use of the three compartment model improved the goodness of fit in comparison to the two compartment model. Values for kinetic rate constants and measures of benzodiazepine receptor binding, including BP and V(3)', were similar to results obtained with the SPECT radioligand [(123)I]iomazenil, and a prior report with low specific activity [(11)C]Iomazenil. Kinetic modeling using the three compartment model with PET and high specific activity [(11)C]Iomazenil provides a reliable measure of benzodiazepine receptor binding. Synapse 35:68-77, 2000. Published 2000 Wiley-Liss, Inc.
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Affiliation(s)
- J D Bremner
- Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Connecticut 06250, USA.
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45
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Bremner JD, Baldwin R, Horti A, Staib LH, Ng CK, Tan PZ, Zea-Ponce Y, Zoghbi S, Seibyl JP, Soufer R, Charney DS, Innis RB. Quantitation of benzodiazepine receptor binding with PET [11C]iomazenil and SPECT [123I]iomazenil: preliminary results of a direct comparison in healthy human subjects. Psychiatry Res 1999; 91:79-91. [PMID: 10515463 DOI: 10.1016/s0925-4927(99)00015-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Although positron emission tomography (PET) and single photon emission computed tomography (SPECT) are increasingly used for quantitation of neuroreceptor binding, almost no studies to date have involved a direct comparison of the two. One study found a high level of agreement between the two techniques, although there was a systematic 30% increase in measures of benzodiazepine receptor binding in SPECT compared with PET. The purpose of the current study was to directly compare quantitation of benzodiazepine receptor binding in the same human subjects using PET and SPECT with high specific activity [11C]iomazenil and [123I]iomazenil, respectively. All subjects were administered a single bolus of high specific activity iomazenil labeled with 11C or 123I followed by dynamic PET or SPECT imaging of the brain. Arterial blood samples were obtained for measurement of metabolite-corrected radioligand in plasma. Compartmental modeling was used to fit values for kinetic rate constants of transfer of radioligand between plasma and brain compartments. These values were used for calculation of binding potential (BP = Bmax/Kd) and product of BP and the fraction of free non-protein-bound parent compound (V3'). Mean values for V3' in PET and SPECT were as follows: temporal cortex 23+/-5 and 22+/-3 ml/g, frontal cortex23+/-6 and 22+/-3 ml/g, occipital cortex 28+/-3 and 31+/-5 ml/g, and striatum 4+/-4 and 7+/-4 ml/g. These preliminary findings indicate that PET and SPECT provide comparable results in quantitation of neuroreceptor binding in the human brain.
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Affiliation(s)
- J D Bremner
- Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT 06520, USA.
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Abstract
A complete remote control system was constructed for production of the PET 5-HT2A ligand [18F]altanserin by nitro-for-fluoro exchange. Comparing with published methods, the key features include (1) conducting azeotropic distillation and nucleophilic displacement in an open vessel heated by a commercial microwave oven; (2) purifying the product by a single HPLC procedure and (3) removing HPLC solvent by solid phase extraction. The preparation took 114 min with 23% yield and high quality.
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Affiliation(s)
- P Z Tan
- VA PET Center, Department of Psychiatry, Yale University School of Medicine, West Haven, CT 06516, USA.
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47
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Bremner JD, Staib LH, Kaloupek D, Southwick SM, Soufer R, Charney DS. Neural correlates of exposure to traumatic pictures and sound in Vietnam combat veterans with and without posttraumatic stress disorder: a positron emission tomography study. Biol Psychiatry 1999; 45:806-16. [PMID: 10202567 PMCID: PMC3233761 DOI: 10.1016/s0006-3223(98)00297-2] [Citation(s) in RCA: 447] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with posttraumatic stress disorder (PTSD) show a reliable increase in PTSD symptoms and physiological reactivity following exposure to traumatic pictures and sounds. In this study neural correlates of exposure to traumatic pictures and sounds were measured in PTSD. METHODS Positron emission tomography and H2[15O] were used to measure cerebral blood flow during exposure to combat-related and neutral pictures and sounds in Vietnam combat veterans with and without PTSD. RESULTS Exposure to traumatic material in PTSD (but not non-PTSD) subjects resulted in a decrease in blood flow in medial prefrontal cortex (area 25), an area postulated to play a role in emotion through inhibition of amygdala responsiveness. Non-PTSD subjects activated anterior cingulate (area 24) to a greater degree than PTSD patients. There were also differences in cerebral blood flow response in areas involved in memory and visuospatial processing (and by extension response to threat), including posterior cingulate (area 23), precentral (motor) and inferior parietal cortex, and lingual gyrus. There was a pattern of increases in PTSD and decreases in non-PTSD subjects in these areas. CONCLUSIONS The findings suggest that functional alternations in specific cortical and subcortical brain areas involved in memory, visuospatial processing, and emotion underlie the symptoms of patients with PTSD.
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Affiliation(s)
- J D Bremner
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
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Soufer R, Bremner JD, Arrighi JA, Cohen I, Zaret BL, Burg MM, Goldman-Rakic P. Cerebral cortical hyperactivation in response to mental stress in patients with coronary artery disease. Proc Natl Acad Sci U S A 1998; 95:6454-9. [PMID: 9600987 PMCID: PMC27794 DOI: 10.1073/pnas.95.11.6454] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/1998] [Indexed: 02/07/2023] Open
Abstract
The central nervous system (CNS) effects of mental stress in patients with coronary artery disease (CAD) are unexplored. The present study used positron emission tomography (PET) to measure brain correlates of mental stress induced by an arithmetic serial subtraction task in CAD and healthy subjects. Mental stress resulted in hyperactivation in CAD patients compared with healthy subjects in several brain areas including the left parietal cortex [angular gyrus/parallel sulcus (area 39)], left anterior cingulate (area 32), right visual association cortex (area 18), left fusiform gyrus, and cerebellum. These same regions were activated within the CAD patient group during mental stress versus control conditions. In the group of healthy subjects, activation was significant only in the left inferior frontal gyrus during mental stress compared with counting control. Decreases in blood flow also were produced by mental stress in CAD versus healthy subjects in right thalamus (lateral dorsal, lateral posterior), right superior frontal gyrus (areas 32, 24, and 10), and right middle temporal gyrus (area 21) (in the region of the auditory association cortex). Of particular interest, a subgroup of CAD patients that developed painless myocardial ischemia during mental stress had hyperactivation in the left hippocampus and inferior parietal lobule (area 40), left middle (area 10) and superior frontal gyrus (area 8), temporal pole, and visual association cortex (area 18), and a concomitant decrease in activation observed in the anterior cingulate bilaterally, right middle and superior frontal gyri, and right visual association cortex (area 18) compared with CAD patients without myocardial ischemia. These findings demonstrate an exaggerated cerebral cortical response and exaggerated asymmetry to mental stress in individuals with CAD.
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Affiliation(s)
- R Soufer
- Yale University/VA Positron Imaging Center, VA Connecticut Healthcare System, Department of Diagnostic Radiology, Yale University School of Medicine, 950 Campbell Avenue, West Haven, CT 06516, USA.
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Jain D, Shaker SM, Burg M, Wackers FJ, Soufer R, Zaret BL. Effects of mental stress on left ventricular and peripheral vascular performance in patients with coronary artery disease. J Am Coll Cardiol 1998; 31:1314-22. [PMID: 9581726 DOI: 10.1016/s0735-1097(98)00092-8] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES We sought to investigate the mechanism of a mental stress-induced fall in left ventricular ejection fraction (LVEF) in patients with coronary artery disease. BACKGROUND Mental stress induces a fall in LVEF in a significant proportion of patients with coronary artery disease. This is accompanied by an increase in heart rate, blood pressure and rate-pressure product. Whether the mental stress-induced fall in LVEF is due to myocardial ischemia, altered loading conditions or a combination of both is not clear. METHODS Left ventricular (LV) function was studied noninvasively by serial equilibrium radionuclide angiocardiography and simultaneous measurement of peak power, a relatively afterload-independent index of LV contractility, in 21 patients with coronary artery disease (17 men, 4 women) and 9 normal subjects (6 men, 3 women) at baseline, during mental stress and during exercise. Peripheral vascular resistance (PVR), cardiac output (CO), arterial and end-systolic ventricular elastance (Ea, Ees,) and ventriculoarterial coupling (V/AC) were also calculated. Patients underwent two types of mental stress-mental arithmetic and anger recall-as well as symptom-limited semisupine bicycle exercise. RESULTS Nine patients (43%) had an absolute fall in LVEF of > or = 5% (Group I) in response to at least one of the mental stressors, whereas the remaining patients did not (Group II). Group I and Group II patients were similar in terms of baseline characteristics. Both groups showed a significant but comparable increase in systolic blood pressure (15+/-7 vs. 9+/-10 mm Hg, p=0.12) and a slight increase in heart rate (7+/-4 vs. 8+/-7 beats/min, p=0.6) and a comparable increase in rate-pressure product (2.2+/-0.9 vs. 1.9+/-1.2 beats/min x mm Hg, p=0.6) with mental stress. However, PVR increased in Group I and decreased in Group II (252+/-205 vs. -42+/-230 dynes x s x cm(-5), p=0.006), and CO decreased in Group I and increased in Group II (-0.2+/-0.4 vs. 0.6+/-0.7 liters/min, p=0.02) with mental stress. There was no difference in the change in peak power (p=0.4) with mental stress. With exercise, an increase in systolic blood pressure, heart rate, rate-pressure product and CO and a fall in PVR were similar in both groups. Of the two mental stressors, anger recall resulted in a greater fall in LVEF and a greater increase in diastolic blood pressure. Exercise resulted in a fall in LVEF in 7 patients (33%). However, exercise-induced changes in LVEF and hemodynamic variables were not predictive of mental stress-induced changes in LVEF and hemodynamic variables. Conclusions. Abnormal PVR and Ea responses to mental stress and exercise are observed in patients with a mental stress-induced fall in LVEF. Peripheral vasoconstrictive responses to mental stress contribute significantly toward a mental stress-induced fall in LVEF.
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Affiliation(s)
- D Jain
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut 06520, USA.
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