Higher Activation of the Rostromedial Prefrontal Cortex During Mental Stress Predicts Major Cardiovascular Disease Events in Individuals With Coronary Artery Disease

• DOI: 10.1161/circulationaha.119.044442
• Publication Date: 2020-06-11T09:00:12Z
• Authors: Kasra Moazzami; Matthew T. Wittbrodt; Bruno B. Lima; Jonathon A. Nye; Puja K. Mehta; Brad D. Pearce; Zakaria Almuwaqqat; Muhammad Hammadah; Oleksiy Levantsevych; Yan V. Sun; Paolo Raggi; Ernest V. Garcia; Margarethe Goetz; Arshed A. Quyyumi; J. Douglas Bremner; Viola Vaccarino; Amit J. Shah
• Keywords: Mace; Unstable angina

Background: Psychological stress is a risk factor for major adverse cardiovascular events (MACE) in individuals with coronary artery disease. Certain brain regions that control both emotional states and cardiac physiology may be involved this relationship. The rostromedial prefrontal cortex (rmPFC) an important region processes regulates immune autonomic functions. Changes rmPFC activity (reactivity) informative of future MACE. Methods: Participants stable disease underwent acute mental testing using series standardized speech/arithmetic stressors simultaneous imaging high-resolution positron emission tomography imaging. We defined high activation as difference between scans greater than the median value entire cohort. Interleukin-6 levels 90 minutes after stress, high-frequency heart rate variability during were also assessed. MACE composite death, myocardial infarction, unstable angina revascularization, failure hospitalization. Results: studied 148 subjects (69% male) mean±SD age 62±8 years. After adjustment baseline demographics, factors, interleukin-6 variability, higher reactivity was independently associated lower stress. During follow-up 3 years, 34 (21.3%) experienced Each increase 1 SD 21% (hazard ratio, 1.21 [95% CI, 1.08–1.37]). Stress-induced explained 15.5% 32.5% relationship MACE, respectively. Addition to conventional factors improved reclassification prediction, C-statistic from 0.71 0.76 ( P =0.03). Conclusions: Greater incident Immune responses play contributory role.