Biopsychosoc Sci Med. 2026 Jan 13. doi: 10.1097/PSY.0000000000001464. Online ahead of print.
ABSTRACT
OBJECTIVE: We studied responses to acute mental stress in individuals with stable coronary artery disease (CAD) with and without heart failure with reduced ejection fraction (HFrEF).
METHODS: Individuals with stable CAD (N=313, 45 with HFrEF) underwent a laboratory-based mental stress. HFrEF was defined as an ejection fraction of <40%. Hemodynamic reactivity, and vasoconstriction during mental stress, were evaluated using changes in systolic blood pressure, and peripheral arterial tonometry, respectively. Immune function was assessed by measuring changes in Interleukin-6 (IL-6) and circulating progenitor cell counts enumerated using flow cytometry of CD34-expressing mononuclear cells before and 90 min after mental stress.
RESULTS: During the mental stress testing, patients in the HFrEF exhibited a smaller (blunted) increase in systolic blood pressure compared to the non HFrEF group (30.4±14.1 vs. 41.9±16.1 mm Hg, P<0.001), greater vasoconstriction (PAT ratio 0.69 ± 0.30 vs. 0.83±0.40, P=0.02), a larger increase in IL-6 levels (0.91±0.11 vs. 0.42±0.14 pg/ml, P=0.01), and larger increases in circulating progenitor cell counts (0.68±0.12 vs. 0.22±0.11 cell/L, P=0.009). After adjustment for demographic and traditional risk factors, each of these four maladaptive stress responses remained independently associated with the presence of HFrEF.
CONCLUSION: Among individuals with stable CAD, presence of HFrEF was independently associated with a blunted systolic blood pressure response, greater vasoconstriction, increased inflammation, and enhanced progenitor cell mobilization with mental stress, a response that is associated with adverse long term outcomes.
PMID:41570332 | DOI:10.1097/PSY.0000000000001464