{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T03:51:48Z","timestamp":1793332308013,"version":"4.5.0"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[1995,10,15]]},"abstract":"<jats:p>\n            <jats:italic>Background<\/jats:italic>\n            The purpose of this study was to determine the correspondence of mental stress\u2013induced ischemia in the laboratory with ambulatory ischemia and to assess the relationship between hemodynamic responses to mental stress and the occurrence of ischemia. Although exercise testing is usually used to elicit myocardial ischemia, ischemia during daily life usually occurs at relatively low heart rates and in the absence of strenuous physical exercise. Mental stress has been shown to trigger ischemic events in the laboratory at lower heart rates but at blood pressures comparable to exercise. We therefore compared the extent to which mental stress and exercise testing identify patients who develop ischemia out of hospital.\n          <\/jats:p>\n          <jats:p>\n            <jats:italic>Methods and Results<\/jats:italic>\n            One hundred thirty-two patients with documented coronary disease and recent evidence of exercise-induced myocardial ischemia underwent 48-hour ambulatory monitoring and radionuclide ventriculography during exercise and mental stress testing. Patients who displayed mental stress\u2013induced ischemia in the laboratory were more likely to exhibit ischemia during daily life (\n            <jats:italic>P<\/jats:italic>\n            &lt;.021). Furthermore, patients who exhibited ischemia during ambulatory monitoring displayed larger diastolic blood pressure (\n            <jats:italic>P<\/jats:italic>\n            &lt;.006), heart rate (\n            <jats:italic>P<\/jats:italic>\n            &lt;.039), and rate-pressure product responses (\n            <jats:italic>P<\/jats:italic>\n            &lt;.018) during mental stress.\n          <\/jats:p>\n          <jats:p>\n            <jats:italic>Conclusions<\/jats:italic>\n            Among patients with prior positive exercise stress tests, mental stress\u2013induced ischemia, defined by new wall motion abnormalities, predicts daily ischemia independent of exercise-induced ischemia. Exaggerated hemodynamic responses during mental stress testing also identify individuals who are more likely to exhibit myocardial ischemia during daily life and mental stress.\n          <\/jats:p>","DOI":"10.1161\/01.cir.92.8.2102","type":"journal-article","created":{"date-parts":[[2012,6,12]],"date-time":"2012-06-12T00:34:42Z","timestamp":1339461282000},"page":"2102-2108","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":133,"title":["Mental Stress\u2013Induced Ischemia in the Laboratory and Ambulatory Ischemia During Daily Life"],"prefix":"10.1161","volume":"92","author":[{"given":"James A.","family":"Blumenthal","sequence":"first","affiliation":[{"name":"From the Department of Psychiatry and Behavioral Sciences (J.A.B., W.J., M.B., E.T.T.), the Department of Medicine (R.A.W., D.J.F., J.J.M., C.O.), and the Department of Radiology (R.E.C., M.H.), Duke University Medical Center, Durham, NC; and the Department of Medical and Clinical Psychology (D.S.K.), Uniformed Services University of the Health Sciences, Bethesda, Md."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Jiang","sequence":"additional","affiliation":[{"name":"From the Department of Psychiatry and Behavioral Sciences (J.A.B., W.J., M.B., E.T.T.), the Department of Medicine (R.A.W., D.J.F., J.J.M., C.O.), and the Department of Radiology (R.E.C., M.H.), Duke University Medical Center, Durham, NC; and the Department of Medical and Clinical Psychology (D.S.K.), Uniformed Services University of the Health Sciences, Bethesda, Md."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert A.","family":"Waugh","sequence":"additional","affiliation":[{"name":"From the Department of Psychiatry and Behavioral Sciences (J.A.B., W.J., M.B., E.T.T.), the Department of Medicine (R.A.W., D.J.F., J.J.M., C.O.), and the Department of Radiology (R.E.C., M.H.), Duke University Medical Center, Durham, NC; and the Department of Medical and Clinical Psychology (D.S.K.), Uniformed Services University of the Health Sciences, Bethesda, Md."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J.","family":"Frid","sequence":"additional","affiliation":[{"name":"From the Department of Psychiatry and Behavioral Sciences (J.A.B., W.J., M.B., E.T.T.), the Department of Medicine (R.A.W., D.J.F., J.J.M., C.O.), and the Department of Radiology (R.E.C., M.H.), Duke University Medical Center, Durham, NC; and the Department of Medical and Clinical Psychology (D.S.K.), Uniformed Services University of the Health Sciences, Bethesda, Md."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James J.","family":"Morris","sequence":"additional","affiliation":[{"name":"From the Department of Psychiatry and Behavioral Sciences (J.A.B., W.J., M.B., E.T.T.), the Department of Medicine (R.A.W., D.J.F., J.J.M., C.O.), and the Department of Radiology (R.E.C., M.H.), Duke University Medical Center, Durham, NC; and the Department of Medical and Clinical Psychology (D.S.K.), Uniformed Services University of the Health Sciences, Bethesda, Md."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. Edward","family":"Coleman","sequence":"additional","affiliation":[{"name":"From the Department of Psychiatry and Behavioral Sciences (J.A.B., W.J., M.B., E.T.T.), the Department of Medicine (R.A.W., D.J.F., J.J.M., C.O.), and the Department of Radiology (R.E.C., M.H.), Duke University Medical Center, Durham, NC; and the Department of Medical and Clinical Psychology (D.S.K.), Uniformed Services University of the Health Sciences, Bethesda, Md."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Hanson","sequence":"additional","affiliation":[{"name":"From the Department of Psychiatry and Behavioral Sciences (J.A.B., W.J., M.B., E.T.T.), the Department of Medicine (R.A.W., D.J.F., J.J.M., C.O.), and the Department of Radiology (R.E.C., M.H.), Duke University Medical Center, Durham, NC; and the Department of Medical and Clinical Psychology (D.S.K.), Uniformed Services University of the Health Sciences, Bethesda, Md."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Babyak","sequence":"additional","affiliation":[{"name":"From the Department of Psychiatry and Behavioral Sciences (J.A.B., W.J., M.B., E.T.T.), the Department of Medicine (R.A.W., D.J.F., J.J.M., C.O.), and the Department of Radiology (R.E.C., M.H.), Duke University Medical Center, Durham, NC; and the Department of Medical and Clinical Psychology (D.S.K.), Uniformed Services University of the Health Sciences, Bethesda, Md."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth T.","family":"Thyrum","sequence":"additional","affiliation":[{"name":"From the Department of Psychiatry and Behavioral Sciences (J.A.B., W.J., M.B., E.T.T.), the Department of Medicine (R.A.W., D.J.F., J.J.M., C.O.), and the Department of Radiology (R.E.C., M.H.), Duke University Medical Center, Durham, NC; and the Department of Medical and Clinical Psychology (D.S.K.), Uniformed Services University of the Health Sciences, Bethesda, Md."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David S.","family":"Krantz","sequence":"additional","affiliation":[{"name":"From the Department of Psychiatry and Behavioral Sciences (J.A.B., W.J., M.B., E.T.T.), the Department of Medicine (R.A.W., D.J.F., J.J.M., C.O.), and the Department of Radiology (R.E.C., M.H.), Duke University Medical Center, Durham, NC; and the Department of Medical and Clinical Psychology (D.S.K.), Uniformed Services University of the Health Sciences, Bethesda, Md."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"O\u2019Connor","sequence":"additional","affiliation":[{"name":"From the Department of Psychiatry and Behavioral Sciences (J.A.B., W.J., M.B., E.T.T.), the Department of Medicine (R.A.W., D.J.F., J.J.M., C.O.), and the Department of Radiology (R.E.C., M.H.), Duke University Medical Center, Durham, NC; and the Department of Medical and Clinical Psychology (D.S.K.), Uniformed Services University of the Health Sciences, Bethesda, Md."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_1_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(83)92295-X"},{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9149(77)80095-7"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(88)90112-9"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(83)80213-7"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(87)90741-1"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF00960618"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(88)90112-9"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198804213181601"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(84)91106-1"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1159\/000418817"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(93)90048-6"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1002\/clc.4960120104"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(94)90169-4"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006842-199101000-00001"},{"key":"e_1_3_2_15_2","unstructured":"Blumenthal JA Kamarck T. Assessment of the type A behavior pattern. In: Blumenthal JA McKee DC eds. Applications in Behavioral Medicine and Health Psychology: A Clinician\u2019s Source Book. Sarasota Fla: Professional Resource Exchange; 1987:3-37."},{"key":"e_1_3_2_16_2","unstructured":"Mettler FA Guiberteau MJ. Cardiovascular system. In: Mettler FA Guiberteau MJ eds. Essentials of Nuclear Medicine Imaging. 2nd ed. Orlando Fla: Grune & Stratton Inc; 1986:151-152."},{"key":"e_1_3_2_17_2","first-page":"617","volume":"21","year":"1980","unstructured":"Brady TJ, Thrall JH, Keyes JW Jr, Brymer JF, Walton JA, Pitt B. Segmental wall-motion analysis in the right anterior oblique projection: comparison of exercise equilibrium radionuclide ventriculography and exercise contrast ventriculography. J Nucl Med. 1980;21:617-621.","journal-title":"J Nucl Med"},{"key":"e_1_3_2_18_2","unstructured":"Fleiss JL. The Design and Analysis of Clinical Experiments New York NY: John Wiley and Sons; 1986."},{"key":"e_1_3_2_19_2","unstructured":"Jiang W Trauner M Waugh R Frid D Coleman RE Hanson M Phillips B Morris J O\u2019Conner C Blumenthal JA. Association of physical fitness is associated with transient myocardial ischemia in the laboratory during mental stress and during daily life. J Cardiopul Rehab. In press."},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(84)90544-1"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.77.1.43"},{"key":"e_1_3_2_22_2","first-page":"1551","volume":"28","year":"1991","unstructured":"Yeung AC, Vekshtein VI, Krantz DK, Vita JA, Ryan TJ Jr, Ganz P, Selwyn AP. The effects of atherosclerosis on the vasomotor responses of coronary arteries to mental stress. N Engl J Med. 1991;28:1551-1556.","journal-title":"N Engl J Med"},{"key":"e_1_3_2_23_2","first-page":"338A","volume":"34","year":"1986","unstructured":"Rebecca G, Wagner R, Zebede T, D\u2019Adamo A, Hanlon B, Sandor T, Ganz P, Selwyn A. Pathogenetic mechanisms causing transient myocardial ischemia with mental arousal in patients with coronary artery disease. Clin Res. 1986;34:338A. Abstract.","journal-title":"Clin Res"},{"key":"e_1_3_2_24_2","unstructured":"L\u2019Abbate A Simonetti I Carpeggiani C Michelassi C. Coronary dynamics and mental arithmetic stress in humans. Circulation. 1991;83(suppl II):II-94-II-99."},{"key":"e_1_3_2_25_2","first-page":"252","volume":"34","year":"1993","unstructured":"Legault SE, Breisblatt WM, Jennings JR, Manuck SB, Follansbee WP. Myocardial ischemia during mental stress testing: is the mechanism different from exercise-induced ischemia? Homeostasis. 1993;34:252-265.","journal-title":"Homeostasis"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(92)90605-X"},{"key":"e_1_3_2_27_2","first-page":"180","volume":"22","year":"1984","unstructured":"Beere PA, Glagov S, Zarsins CK. Retarding effect of lowered heart rate on coronary atherosclerosis. Science. 1984;22:180-182.","journal-title":"Science"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.76.6.3677359"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(90)90032-V"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.68.12.560"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.77.1.3335065"}],"container-title":["Circulation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/01.CIR.92.8.2102","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,12]],"date-time":"2024-05-12T15:33:52Z","timestamp":1715528032000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/01.CIR.92.8.2102"}},"subtitle":["Association and Hemodynamic Features"],"short-title":[],"issued":{"date-parts":[[1995,10,15]]},"references-count":31,"journal-issue":{"issue":"8","published-print":{"date-parts":[[1995,10,15]]}},"alternative-id":["10.1161\/01.CIR.92.8.2102"],"URL":"https:\/\/doi.org\/10.1161\/01.cir.92.8.2102","relation":{},"ISSN":["0009-7322","1524-4539"],"issn-type":[{"value":"0009-7322","type":"print"},{"value":"1524-4539","type":"electronic"}],"subject":[],"published":{"date-parts":[[1995,10,15]]},"assertion":[{"value":"1994-08-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"1995-05-16","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"1995-10-15","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}