A meta-analysis on the prevalence, associated factors and diagnostic methods of mental stress induced myocardial ischemia

Lijun Zhang; Yanping Bao; Xi Wang; Yuxin Zhou; Shuhui Tao; Wan Xu; Meiyan Liu

doi:10.1186/s12967-020-02383-z

A meta-analysis on the prevalence, associated factors and diagnostic methods of mental stress induced myocardial ischemia

J Transl Med. 2020 May 29;18(1):218. doi: 10.1186/s12967-020-02383-z.

Authors

Lijun Zhang¹, Yanping Bao², Xi Wang¹, Yuxin Zhou³, Shuhui Tao^{1

4}, Wan Xu¹, Meiyan Liu⁵

Affiliations

¹ Cardiology Department, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.
² National Institute on Drug Dependence, Peking University, No. 38, Xueyuan Road, Haidian District, Beijing, 10091, China. baoyp@bjmu.edu.cn.
³ Department of Anatomy and Neurobiology, Boston University, Boston, USA.
⁴ School of Basic Medical Sciences, Henan University, Kaifeng, China.
⁵ Cardiology Department, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China. liumeiyanaz@ccmu.edu.cn.

Abstract

Background: The high prevalence of mental stress induced myocardial ischemia (MSIMI) causes double risk of adverse cardiac events in patients with MSIMI. However, multiple types of mental stress, diagnostic techniques, and diagnostic measurements may increase the complexity and heterogeneity in the assessment of MSIMI. Therefore, we performed this meta-analysis to assess the prevalence, associated factors, and diagnostic methods of MSIMI.

Methods: We systematically searched PubMed, EMBACE, Web of Science, CNKI, Wanfang through 1 Feb 2020 in English and Chinese. Review Manager (RevMan) Version 5.3 and Stata 12.0 were used for data analyses.

Results: Twenty articles were enrolled. The pooled estimates for the prevalence of MSIMI in CAD patients was 32%. Potential associated factors of MSIMI involved history of post myocardial infarction (MI), or coronary artery bypass graft (CABG) (RR: 1.29, 95% CI 1.00-1.66, P = 0.05; RR: 1.59, 95% CI 1.00-2.52, P = 0.05). Evidence supported that diagnostic methods could influence the prevalence of MSIMI. Significant differences of MSIMI prevalence were found in different types of mental stress (Public Speaking: 22%; Mental arithmetic: 26%; Anger recall: 34%; Two types: 37%; Three or more than three types: 43%, P = 0.02), diagnostic techniques (SPECT: 26%; RNV: 38%; ECG: 16%; Echocardiography: 41%; Two types: 43%, P < 0.0001), and diagnostic measurements (LVEF decrease: 19%; WMA: 51%; ST depression: 16%; MPD: 26%; Two or more than two measurements: 45%, P < 0.00001). Moreover, univariate meta-regression demonstrated that MSIMI was linked with mental stress (exp(b): 1.0508, SE: 0.0201, P: 0.018).

Conclusions: This meta-analysis implicated that patients with diabetes, post MI or CABG might be more vulnerable to MSIMI. However, the prevalence of MSIMI could be influenced by diagnostic methods, especially the adopted types of mental stress, diagnostic techniques and measurements. Therefore, it is necessary to formulate a standard diagnostic method for MSIMI, which should be adequate, assessable, and affordable worldwide. Registration PROSPERO. Online Protocol: CRD42020162822.

Keywords: Diagnostic method; Mental stress; Meta-regression; Myocardial ischemia.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't

MeSH terms

Coronary Artery Disease*
Humans
Myocardial Infarction*
Myocardial Ischemia* / diagnosis
Myocardial Ischemia* / epidemiology
Prevalence
Stress, Psychological / complications