Mental Stress Reactivity in Women With CMD

Planar late Heart to Mediastinal Ratio (MIBG imaging)

The research team will compare resting sympathetic activity measured with 123I-meta-iodobenzylguanidine (MIBG) imaging between CMD women and the two control groups. The heart to the mediastinal ratio (HMR) which is an index of MIBG uptake will be calculated as per standard methods. The HMR reflects norepinephrine kinetics. Higher sympathetic activity and turnover cause less MIBG to be retained and result in a lower HMR. MIBG SPECT defect score will be determined by late (4 hours) MIBG uptake by visual blind scoring using the standard 17-segment model with 0=normal tracer uptake, 1=mildly reduced uptake, 2=moderately reduced uptake, 3=severely reduced uptake, 4=absent tracer uptake, as defined by Bax et al.

Changes in HRV with mental stress

The research team will also compare autonomic reactivity during a standardized mental stress test, including heart rate variability (HRV) between CMD women and the two control groups

Changes in pre-ejection period (PEP) with mental stress

The research team will also compare autonomic reactivity during a standardized mental stress test, including the pre-ejection period (PEP) between CMD women and the two control groups. This measures systolic time interval and reflects cardiac contractility (which is under the beta-adrenergic influence). Impedance ECG measures PEP from the onset of ventricular depolarization (Q-wave on ECG) to the opening of the aortic valve for ejection of blood from the left ventricle.

Changes in flow mediated dilation (FMD test) to acute mental stress in CMD women.

The research team will compare peripheral microvascular vasoconstriction during mental stress, as well as changes in peripheral microvascular function and flow-mediated dilation with mental stress, between CMD women and the two control groups. Readings of blood flow in one of the arteries of the arm using an ultrasound. Then a blood pressure cuff will be placed around the forearm and will be inflated to stop the flow of blood for 5 minutes. After 5 minutes, the blood pressure cuff will be deflated and the readings taken again.

Changes in Peripheral arterial tonometry (PAT) test to acute mental stress in CMD women.

The research team will compare peripheral microvascular vasoconstriction during mental stress, as well as changes in peripheral microvascular function and flow-mediated dilation with mental stress, between CMD women and the two control groups. A blood pressure cuff will be placed on one arm, and probes will be placed on the fingers. In order to get a good tracing, the participant will need to remain quiet and very still for at least 5 minutes. Then, the blood pressure cuff will be inflated for 5 minutes, and more recordings will be done. At the end of the 5 minutes, the blood pressure cuff will be deflated, but to obtain the final tracings, the participant should lie still for another 5-10 minutes.

Examine whether chronic stress burden and autonomic dysfunction during daily life is elevated in CMD women.

The research team will compare anginal symptoms, chronic and daily life stress, and autonomic function measured during one week of home monitoring between CMD and the two control groups. Participants will use a smartphone to track their symptoms and stress.

Stressor frequency over 7 days

Participants will use the Actiwatch® Spectrum Pro (Philips-Respironics, Inc.) wristwatch-style actigraphs containing a calibrated accelerometer that records movement activity in discrete epochs and detects physical activity as well as onset and offset of sleep. It provides sleep quality parameters which will be a useful addition to our analysis, as sleep quality is related to stress.

Assessment of quality of life and relationship to anginal symptoms

Anginal symptoms and quality of life will be assessed at 12 months of follow-up. MACE and angina hospitalization will also be obtained. Participants will complete the Seattle Angina Questionnaire (SAQ). SAQ asks questions about daily activities and how many limitations they experience due to chest pain, chest tightness, or angina over the past 4weeks. Scored by assigning each response an ordinal value, beginning with 1 for the response that implies the lowest level of functioning, and summing across items within each of the five scales. Scale scores are then transformed into a 0- 100 range by subtracting the lowest possible scale score, dividing by the range of the scale, and multiplying by 100. Because each scale monitors a unique dimension of coronary artery disease, no summary score is generated.

Assessment of general health status

SF-36v2 Health Survey measures functional health and well-being from the patient's point of view. It consists of eight scales yielding two summary measures: physical and mental health. The physical health measure includes four scales of physical functioning, role-physical, bodily pain, and general health. The mental health measure is composed of vitality, social functioning, role-emotional, and mental health. A final item, termed self-reported health transition, is answered but is not included in the scoring process. The SF-36 offers a choice of recall format: standard (4 weeks) or acute (1 week) time frame. Likert scales and yes/no options are used to assess function and well-being. To score the SF-36, scales are standardized with a scoring algorithm or by the SF-36v2 scoring software to obtain a score ranging from 0 to 100. Higher scores indicate better health status, and a mean score of 50 has been articulated as a normative value for all scales.

Changes in injury and inflammation biomarker with mental stress among the three groups.

The research team will administer questionnaires and different types of mental stress tests, including a speech task over a situation that made participant upset or angry, and/or a math test. Blood will be drawn to measure inflammatory biomarker.