Platelet aggregation and mental stress induced myocardial ischemia: Results from the Responses of Myocardial Ischemia to Escitalopram Treatment (REMIT) study.
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BACKGROUND: Mental stress-induced myocardial ischemia (MSIMI) is common in patients with ischemic heart disease (IHD) and associated with a poorer cardiovascular prognosis. Platelet hyperactivity is an important factor in acute coronary syndrome. This study examined associations between MSIMI and resting and mental stress-induced platelet activity. METHODS: Eligible patients with clinically stable IHD underwent a battery of 3 mental stress tests during the recruitment phase of REMIT study. MSIMI was assessed by echocardiography and electrocardiography. Ex vivo platelet aggregation in response to ADP, epinephrine, collagen, serotonin, and combinations of serotonin plus ADP, epinephrine, and collagen were evaluated as was platelet serotonin transporter expression. RESULTS: Of the 270 participants who completed mental stress testing, and had both resting and post-stress platelet aggregation evaluation , 43.33% (n=117) met criteria for MSIMI and 18.15% (n=49) had normal left ventricular response to stress (NLVR). The MSIMI group, relative to the NLVR groups, demonstrated heightened mental stress-induced aggregation responses, as measured by area under the curve, to collagen 10μM (6.95[5.54] vs. -14.23[8.75].; P=0.045), epinephrine 10μM (12.84[4.84] vs. -6.40[7.61].; P=0.037) and to serotonin 10 μM plus ADP 1 μM (6.64[5.29] vs. -27.34[8.34]; P<.001). The resting platelet aggregation and serotonin transporter expression, however, were not different between the two groups. CONCLUSIONS: These findings suggest that the dynamic change of platelet aggregation caused by mental stress may underlie MSIMI. While the importance of these findings requires additional investigation, they raise concern given the recognized relationship between mental stress-induced platelet hyperactivity and cardiovascular events in patients with IHD.
Serotonin Uptake Inhibitors
Published Version (Please cite this version)10.1016/j.ahj.2014.12.002
Publication InfoJiang, Wei; Boyle, Stephen H; Ortel, Thomas L; Samad, Zainab; Velazquez, Eric J; Harrison, Robert W; ... Becker, Richard C (2015). Platelet aggregation and mental stress induced myocardial ischemia: Results from the Responses of Myocardial Ischemia to Escitalopram Treatment (REMIT) study. Am Heart J, 169(4). pp. 496-507.e1. 10.1016/j.ahj.2014.12.002. Retrieved from https://hdl.handle.net/10161/15033.
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Medical Instructor in the Department of Psychiatry and Behavioral Sciences
One focus of my research has been to identity psychosocial factors that predict the development of CHD and disease progression among patients with established CHD. This research has considered the roles of both negative (e.g. anger, hostility, depressive symptoms, anxiety) and positive (i.e. positive emotion, Openness to Experience, recovery expectations) dispositions. My research has also focused on delineating mechanisms that underlie the associations between psychosocial factors and corona
Assistant Professor of Medicine
Professor of Psychiatry and Behavioral Sciences
Dr. Wei Jiang leads the Neuropsychocardiology laboratory at Duke University Medical Center. Dr. Jiang's main research interests include understanding the interplay between the mind-brain activity and cardiovascular system, and discovering interventions that modify the negative impact of negative emotions on the cardiovascular system. Her research covers the spectrum of epidemiological cohort study, translational investigation, clinical trials, and implementational evaluation. Another research ar
Professor of Pharmacology and Cancer Biology
This laboratory uses a multidisciplinary approach using both animal and model systems to study the biology of addiction and stress/depression. We are specifically interested in how adolescence and the hormonal changes of puberty and aging influence vulnerability to these conditions. Specific projects underway include: (1) the biology of sex differences in addictive drug action, (2) role of maturing dopamine systems in the onset of drug taking during adolescence, (3) the neurobiology of adoles
Richard Sean Stack, M.D. Distinguished Professor
Dr. O’Connor’s research interests include: acute heart failure; co-morbidities in heart failure; clinical trials; biomarkers; and novel pharmacological and non-pharmacological approaches for the treatment of heart failure.
Chief, Division of Hematology in the Department of Medicine
My research program investigates the molecular mechanisms whereby various congenital and acquired abnormalities result in ‘dysfunctional’ hemostasis (i.e., hemorrhage or thrombosis) to better understand the molecular mechanisms and interactions that are necessary for normal hemostasis. We are particularly interested in the mechanisms whereby antibodies and other inhibitors can interfere with normal hemostatic mechanisms. Several projects extensively overlap and focus on the as
Adjunct Associate Professor in the Department of Medicine
Dr. Zainab Samad is chairwoman of the Department of Medicine at Aga Khan University (AKU) in Pakistan and currently serves as an Adjunct Associate Professor of Medicine at Duke University. She attended Medical School at the Aga Khan University Medical College in Karachi, Pakistan and thereafter completed her residency training in Internal Medicine and fellowship in Cardiology at Duke University Medical Center in Durham, North Carolina. Additionally, she completed advanced tra
Adjunct Professor in the Department of Medicine
LeadershipEric J. Velazquez, MD, is a Professor of Medicine with tenure at Duke University. As section chief for Cardiovascular Imaging in the Division of Cardiology and director of the Cardiac Diagnostic Unit and Echocardiography Laboratories for Duke University Health System, he coordinates a high-volume enterprise and an outstanding group of clinician-investigators and clinical staff who make important contributions across patient care, research and educational
This author no longer has a Scholars@Duke profile, so the information shown here reflects their Duke status at the time this item was deposited.
Professor of Psychiatry and Behavioral Sciences
My research aims to identify psychosocial factors that are involved in the pathogenesis and course of major medical disorders, to characterize the biobehavioral mechanisms whereby such factors influence disease, and to develop both behavioral and pharmacologic means of preventing or ameliorating the adverse impact of psychosocial factors on health and disease. Specific projects that are currently active include: 1) The influence of hostile personality, social isolation, depression and other psyc
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