{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T20:05:45Z","timestamp":1786392345193,"version":"build-2736575974"},"reference-count":43,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2023,3,27]],"date-time":"2023-03-27T00:00:00Z","timestamp":1679875200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Premio Canada-Italia per l\u2019Innovazione 2022"},{"name":"Ricerca Corrente funding scheme of the Italian Ministry of Health"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmaceuticals"],"abstract":"<jats:p>Little is known about physiological and psychological responses to mental stress in stable patients affected by pulmonary arterial hypertension (PAH). The current explorative controlled pilot study was conducted to investigate whether heart rate (HR) and perceived stress would differ during standardized mental stress testing in PAH patients compared to healthy subjects. Correlation analysis between HR, perceived stress, participants\u2019 psychological status and performance on the mental stress task was also performed. The study included 13 female PAH patients (average age: 44.38 \u00b1 10.88 years; average education: 14 \u00b1 3.07 years; mean duration of illness: 9.15 \u00b1 5.37 years) and 13 female controls similar in age (mean age: 47.85 \u00b1 6.36 years) and education (15.92 \u00b1 1.55 years). Participants performed a standardized 9 min mental stress test (computer based, adaptive math task). HR and perceived stress during the task were compared to resting baseline and correlated with psychological state and task performance. Both HR and perceived stress significantly increased during mental stress in a similar way in both groups. A significant correlation was found between HR and perceived stress. Our data show that moderate mental stress has a comparable effect on HR and perceived stress increase in stable PAH patients and control subjects.<\/jats:p>","DOI":"10.3390\/ph16040493","type":"journal-article","created":{"date-parts":[[2023,3,27]],"date-time":"2023-03-27T03:31:48Z","timestamp":1679887908000},"page":"493","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Physiological and Psychological Response to Acute Mental Stress in Female Patients Affected by Chronic Pulmonary Arterial Hypertension: An Explorative Controlled Pilot Trial"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3216-1784","authenticated-orcid":false,"given":"Alessandra","family":"Gorini","sequence":"first","affiliation":[{"name":"Istituti Clinici Scientifici Maugeri IRCCS, 20138 Milan, Italy"},{"name":"Dipartimento di Scienze Cliniche e di Comunit\u00e0, Universit\u00e0 degli Studi di Milano, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5360-3137","authenticated-orcid":false,"given":"Beatrice","family":"De Maria","sequence":"additional","affiliation":[{"name":"Istituti Clinici Scientifici Maugeri IRCCS, 20138 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrycja","family":"Krasinska","sequence":"additional","affiliation":[{"name":"Istituti Clinici Scientifici Maugeri IRCCS, 20138 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3520-249X","authenticated-orcid":false,"given":"Maurizio","family":"Bussotti","sequence":"additional","affiliation":[{"name":"Istituti Clinici Scientifici Maugeri IRCCS, 20138 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3973-6931","authenticated-orcid":false,"given":"Francesca","family":"Perego","sequence":"additional","affiliation":[{"name":"Istituti Clinici Scientifici Maugeri IRCCS, 20138 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6516-0959","authenticated-orcid":false,"given":"Laura Adelaide","family":"Dalla Vecchia","sequence":"additional","affiliation":[{"name":"Istituti Clinici Scientifici Maugeri IRCCS, 20138 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"508","DOI":"10.21037\/jtd.2018.01.90","article-title":"Exercise training in pulmonary arterial hypertension","volume":"10","author":"Bussotti","year":"2018","journal-title":"J. Thorac. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"D42","DOI":"10.1016\/j.jacc.2013.10.032","article-title":"Definitions and diagnosis of pulmonary hypertension","volume":"62","author":"Hoeper","year":"2013","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1164\/rccm.200510-1668OC","article-title":"Pulmonary arterial hypertension in France: Results from a national registry","volume":"173","author":"Humbert","year":"2006","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1183\/09031936.00092306","article-title":"An epidemiological study of pulmonary arterial hypertension","volume":"30","author":"Peacock","year":"2007","journal-title":"Eur. Respir. J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1161\/CIRCULATIONAHA.113.004526","article-title":"Anticoagulation and survival in pulmonary arterial hypertension: Results from the Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension (COMPERA)","volume":"129","author":"Olsson","year":"2014","journal-title":"Circulation"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"216","DOI":"10.7326\/0003-4819-107-2-216","article-title":"Primary pulmonary hypertension. A national prospective study","volume":"107","author":"Rich","year":"1987","journal-title":"Ann. Intern. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1378\/chest.10-0075","article-title":"The changing picture of patients with pulmonary arterial hypertension in the United States: How REVEAL differs from historic and non-US Contemporary Registries","volume":"139","author":"Frost","year":"2011","journal-title":"Chest"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/j.ccl.2020.01.009","article-title":"Pathophysiology of Acute and Chronic Right Heart Failure","volume":"38","author":"Thandavarayan","year":"2020","journal-title":"Cardiol. Clin."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.ijcard.2008.12.087","article-title":"Heart rate variability predicts outcome in children with pulmonary arterial hypertension","volume":"142","author":"Lammers","year":"2010","journal-title":"Int. J. Cardiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1186\/s12931-017-0679-6","article-title":"Autonomic nervous system involvement in pulmonary arterial hypertension","volume":"18","author":"Vaillancourt","year":"2017","journal-title":"Respir. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1183\/09031936.00145708","article-title":"Impaired cardiac autonomic control relates to disease severity in pulmonary hypertension","volume":"34","author":"Wensel","year":"2009","journal-title":"Eur. Respir. J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1007\/s00408-003-1034-x","article-title":"Ventricular arrhythmias and autonomic profile in patients with primary pulmonary hypertension","volume":"181","author":"Folino","year":"2003","journal-title":"Lung"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"63","DOI":"10.3389\/fped.2015.00063","article-title":"Heart Rate Variability is Related to Disease Severity in Children and Young Adults with Pulmonary Hypertension","volume":"3","author":"Latus","year":"2015","journal-title":"Front. Pediatr."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Tang, S.Y., Ma, H.P., Hung, C.S., Kuo, P.H., Lin, C., Lo, M.T., Hsu, H.H., Chiu, Y.W., Wu, C.K., and Tsai, C.H. (2021). The Value of Heart Rhythm Complexity in Identifying High-Risk Pulmonary Hypertension Patients. Entropy, 23.","DOI":"10.21203\/rs.3.rs-251946\/v1"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"10710","DOI":"10.1038\/s41598-019-47144-1","article-title":"Heart Rhythm Complexity Impairment in Patients with Pulmonary Hypertension","volume":"9","author":"Tsai","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1016\/j.biopsycho.2005.11.013","article-title":"The role of vagal function in the risk for cardiovascular disease and mortality","volume":"74","author":"Thayer","year":"2007","journal-title":"Biol. Psychol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/j.ijcard.2009.09.543","article-title":"The relationship of autonomic imbalance, heart rate variability and cardiovascular disease risk factors","volume":"141","author":"Thayer","year":"2010","journal-title":"Int. J. Cardiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1111\/1467-8721.01246","article-title":"The Psychobiology of Stress","volume":"12","author":"Kemeny","year":"2003","journal-title":"Curr. Dir. Psychol. Sci."},{"key":"ref_19","unstructured":"Turner, J.R. (1994). Cardiovascular Reactivity and Stress: Patterns of Physiological Response, Springer Science & Business Media."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/S0002-8703(03)00182-0","article-title":"Heart rate and blood pressure responses to mental stress and clinical cardiovascular events in men and women after coronary artery bypass grafting: The Post Coronary Artery Bypass Graft (Post-CABG) biobehavioral study","volume":"146","author":"Herd","year":"2003","journal-title":"Am. Heart J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1292","DOI":"10.1016\/S0002-9149(99)00560-3","article-title":"Prognostic value of mental stress testing in coronary artery disease","volume":"84","author":"Krantz","year":"1999","journal-title":"Am. J. Cardiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1097\/00006842-199201000-00003","article-title":"Does cardiovascular reactivity to mental stress have prognostic value in postinfarction patients? A pilot study","volume":"54","author":"Manuck","year":"1992","journal-title":"Psychosom Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/j.jchf.2014.12.016","article-title":"Cardiovascular reactivity to mental stress and mortality in patients with heart failure","volume":"3","author":"Kupper","year":"2015","journal-title":"JACC Heart Fail."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"314","DOI":"10.3389\/fphys.2013.00314","article-title":"Cardiovascular reactivity, stress, and physical activity","volume":"4","author":"Huang","year":"2013","journal-title":"Front. Physiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1207\/s15327558ijbm1102_3","article-title":"Depressive symptoms and cardiovascular reactivity to laboratory behavioral stress","volume":"11","author":"Kibler","year":"2004","journal-title":"Int. J. Behav. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1037\/a0013001","article-title":"Major depressive disorder is associated with attenuated cardiovascular reactivity and impaired recovery among those free of cardiovascular disease","volume":"28","author":"Salomon","year":"2009","journal-title":"Health Psychol."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Souza, G.G., Mendonca-de-Souza, A.C., Duarte, A.F., Fischer, N.L., Souza, W.F., Coutinho, E.S., Figueira, I., and Volchan, E. (2015). Blunted cardiac reactivity to psychological stress associated with higher trait anxiety: A study in peacekeepers. BMC Neurosci., 16.","DOI":"10.1186\/s12868-015-0216-9"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1046\/j.1365-2281.2000.00287.x","article-title":"Mental stress increases right heart afterload in severe pulmonary hypertension","volume":"20","author":"Schachinger","year":"2000","journal-title":"Clin. Physiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"235","DOI":"10.30773\/pi.2017.08.17","article-title":"Stress and Heart Rate Variability: A Meta-Analysis and Review of the Literature","volume":"15","author":"Kim","year":"2018","journal-title":"Psychiatry Investig."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Dalla Vecchia, L.A., Barbic, F., De Maria, B., Cozzolino, D., Gatti, R., Dipaola, F., Brunetta, E., Zamuner, A.R., Porta, A., and Furlan, R. (2019). Can strenuous exercise harm the heart? Insights from a study of cardiovascular neural regulation in amateur triathletes. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0216567"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1016\/j.comppsych.2015.04.005","article-title":"The Italian version of the Depression Anxiety Stress Scales-21: Factor structure and psychometric properties on community and clinical samples","volume":"60","author":"Bottesi","year":"2015","journal-title":"Compr. Psychiatry"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/0005-7967(94)00075-U","article-title":"The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories","volume":"33","author":"Lovibond","year":"1995","journal-title":"Behav. Res. Ther."},{"key":"ref_33","first-page":"319","article-title":"The Montreal Imaging Stress Task: Using Functional Imaging to Investigate the Effects of Perceiving and Processing Psychosocial Stress in the Human Brain","volume":"30","author":"Dedovic","year":"2005","journal-title":"J. Psych. Neurosci."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.ijpsycho.2018.02.016","article-title":"Heart rate variability during acute psychosocial stress: A randomized cross-over trial of verbal and non-verbal laboratory stressors","volume":"127","author":"Brugnera","year":"2018","journal-title":"Int. J. Psychophysiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.compind.2017.05.004","article-title":"Detecting Work-Related Stress with a Wearable Device","volume":"90","author":"Han","year":"2017","journal-title":"Comput. Ind."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"13545","DOI":"10.1109\/ACCESS.2017.2723622","article-title":"Machine Learning Framework for the Detection of Mental Stress at Multiple Levels","volume":"5","author":"Subhani","year":"2017","journal-title":"IEEE Access"},{"key":"ref_37","first-page":"361","article-title":"Subjective Units of Distress Scale","volume":"18","author":"McCabe","year":"2015","journal-title":"J. Phobias Psychol. Irrational Fear"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/0165-1838(91)90036-3","article-title":"Assessment of the neural control of the circulation during psychological stress","volume":"35","author":"Pagani","year":"1991","journal-title":"J. Auton. Nerv. Syst."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"349","DOI":"10.2147\/VHRM.S147173","article-title":"Anxiety and depression in patients with pulmonary hypertension: Impact and management challenges","volume":"14","author":"Bussotti","year":"2018","journal-title":"Vasc. Health Risk Manag."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1186\/1465-9921-7-55","article-title":"Cognitive, emotional, and quality of life outcomes in patients with pulmonary arterial hypertension","volume":"7","author":"White","year":"2006","journal-title":"Respir. Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1289","DOI":"10.1164\/rccm.202204-0726LE","article-title":"Cognitive Dysfunction in Patients with Pulmonary Hypertension","volume":"206","author":"Yuan","year":"2022","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1016\/j.yhbeh.2010.08.018","article-title":"Pre-experience of social exclusion suppresses cortisol response to psychosocial stress in women but not in men","volume":"58","author":"Weik","year":"2010","journal-title":"Horm. Behav."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"3","DOI":"10.2174\/1871529X16666161130123937","article-title":"Effects of an Outpatient Service Rehabilitation Programme in Patients Affected by Pulmonary Arterial Hypertension: An Observational Study","volume":"17","author":"Bussotti","year":"2017","journal-title":"Cardiovasc. Hematol. Disord. Drug Targets"}],"container-title":["Pharmaceuticals"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8247\/16\/4\/493\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:03:40Z","timestamp":1760123020000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8247\/16\/4\/493"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,27]]},"references-count":43,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2023,4]]}},"alternative-id":["ph16040493"],"URL":"https:\/\/doi.org\/10.3390\/ph16040493","relation":{},"ISSN":["1424-8247"],"issn-type":[{"value":"1424-8247","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,27]]}}}