Speakers
Prof. Lan GUO
Chief Physician, Department of Cardiac Rehabilitation, Guangdong Cardiovascular Institute, Provincial People’s Hospital, China
Dr. Guo is the chief physician of the department of cardiac rehabilitation, Guangdong Cardiovascular Institute, Guangdong, Provincial People’s Hospital, Guangdong Academy of Medical Sciences. She has been engaged in cardiac rehabilitation for more than 30 years. She is specialised in the routine clinical and rehabilitation treatment of coronary heart disease, hypertension, hyperlipidemia, heart failure and other cardiovascular diseases. In particular, she has rich experience in the design and evaluation of rehabilitation program, and the recognition and management of psychological disorders after cardiac surgery. She initially nationwidely organized training courses on cardiovascular rehabilitation, hosted and participated in a number of scientific research projects on cardiac rehabilitation, and has published more than 30 scientific research papers on cardiac rehabilitation. She is the Vice Chairman of the Cardiovascular Professional Committee of the Chinese Society of Rehabilitation Medicine, the Chairman of the Cardiopulmonary Rehabilitation Committee of the Rehabilitation Physician Branch of the Chinese Medical Doctor Association, the editorial board member of the Cardiovascular Rehabilitation Journal. Moreover she is the compilation of multiple rehabilitation textbooks on cardiac rehabilitation, and participated in the compilation of multiple consensus on cardiac rehabilitation prevention and rehabilitation.
Abstract
Current Understanding on Mental Stress-induced Myocardial Ischaemia
Mental stress-induced myocardial ischemia (MSIMI) is a transient myocardial ischemic response to mental stress that can be induced in patients with coronary artery disease (CAD) during a standardized mental stress challenge, which is different from exercise-induced myocardial ischemia (ESIMI). 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. Recently，the prevalence of MSIMI in patients with ischemic heart disease is as high as 70%. Notably, patients with CAD are more likely to develop MSIMI under the influence of factors, such as age, sex, and psychosocial characteristics. The mechanism of MSIMI involves systemic vascular resistance, endothelial function, microvascular dysfunction, Sex differences in platelet reactivity, peripheral vasoconstrictive responses, brain, and demand/supply mismatch. MSIMI has a twofold increased risk of a combined end point of cardiac events or total mortality. MSIMI not only affects the quality of life of patients but also leads to the deterioration of clinical prognosis and an increased risk of death, especially in young women. Nevertheless, the diagnostic criteria, pathogenesis, cardiovascular imaging, and treatment of MSIMI are still in the clinical exploration stage. Hence, considering recent studies, this paper summarizes the research status of MSIMI from the aspects of mechanism, cardiovascular imaging, diagnosis, and treatment strategies to provide a theoretical basis for the follow-up diagnostic methods and treatment guidelines for MSIMI.