Impact of Mindfulness Based Stress Reduction Therapy on Myocardial Function and Endothelial Dysfunction in Female Patients with Microvascular Angina

BACKGROUND: Mindfulness-based stress reduction (MBSR) is a structured group program that employs mindfulness meditation to alleviate suffering associated with physical, psychosomatic, and psychiatric disorders. In this study, we investigate the impact of MBSR on left ventricular (LV) and endothelial function in female patients with microvascular angina. METHODS: A total of 34 female patients (mean age 52.2 ± 13.8 years) diagnosed with microvascular angina underwent a MBSR program with anti-anginal medication for 8 weeks. The global longitudinal strain (GLS) of the LV was used as a parameter to assess myocardial function and reactive brachial flow-mediated dilatation (FMD) was used to assess endothelial function. Symptoms were analyzed by the Symptom Checklist 90 Revised to determine emotional stress. Changes in GLS and FMD between baseline and post-MBSR were analyzed. RESULTS: After 8 weeks of programmed MBSR treatment, stress parameters were significantly decreased. In addition, GLS (−19.5 ± 2.1% vs. −16.6 ± 2.5%, p < 0.001) and reactive FMD significantly improved (8.9 ± 3.0% vs. 6.9 ± 2.6%, p = 0.005) after MBSR compared to baseline. The changes in GLS correlated to changes in FMD (r = 0.120, p = 0.340) and with the changes in most stress parameters. CONCLUSION: MBSR has beneficial impacts on myocardial and endothelial function in female patients with microvascular angina.

Women, Stress and Heart Health: Mindfulness-Based Stress Reduction and Cardiovascular Disease / 고신대학교의과대학학술지

Psychological stress including depression and anxiety are independent risk factors for cardiovascular disease morbidity and mortality, especially in women. Emotional regulation plays a mediating role in the development of depression and physical illness, and can alter resting physiologic responses associated with the stress response. Mindfulness-based stress reduction (MBSR) is a structured group program that employs mindfulness meditation to alleviate suffering associated with physical, psychosomatic, and psychiatric disorders. MBSR was originally developed for the management of chronic pain, which is now used widely to reduce psychological morbidity associated with chronic illnesses and to treat emotional and behavioral disorders. In cardiovascular disease, MBSR may be helpful for controlling several risk factors for coronary heart disease such as hypertension, type 2 diabetes mellitus, dyslipidemia, oxidative and psychosocial stress, obesity, and smoking, and improvements in submaximal exercise responses and heart rate variability. Although the most effective mode of stress reduction therapy is yet to be established, increasing recognition is being given to MBSR therapy.

Assessment of Left Ventricular Function in Symptomatic Patients with Myocardial Bridge using Two-Dimensional Strain

BACKGROUND AND OBJECTIVES: We wanted to perform quantitative echocardiographic assessment of myocardial function in the patients with myocardial bridge by measuring 2-dimensional strain with using newly developed software. SUBJECTS AND METHODS: Novel computer software was used for tracking heart tissue on echocardiography, and we conducted an advanced wall-motion analysis for 18 symptomatic patients (mean age: 57.1+/-9.7 years, 10 female) with myocardial bridging of the left anterior descending coronary artery and also 20 age-matched healthy controls. The conventional wall-motion scoring was normal in all the patients, and the software was able to adequately track their heart tissue. RESULTS: The maximal angiographic systolic lumen diameter reduction within the myocardial bridges was 71+/-12.6% at rest, with a persistent diameter reduction of 31.2+/-11.3%. The radial strain and displacement of the anterior segments were more significantly reduced than that of the posterior segments at the level of the papillary muscle (30.9+/-13.8% vs. 51.8+/-17.3% and 4.8+/-0.9 vs. 5.9+/-1.5, respectively, all p<0.05), and this showed a plateau (39% and 33%, respectively) or biphasic (50% and 56%, respectively) pattern. The time from the R wave on electrocardiography to the transition from regional systole to early diastolic lengthening (Tr) was significantly delayed in the patients with myocardial bridge more than that for the controls (497+/-20.4 ms vs. 348+/-12.5 ms, respectively, p<0.05). CONCLUSION: Delayed systolic contraction and diastolic relaxation are important mechanisms that contribute to ischemia in the patients with myocardial bridge. 2-dimensional strain can be used to achieve real-time wall-motion analysis, and it has the potential to improve the identification and functional quantification of myocardial Bridge.

Echocardiographic Assessment of LV Geometric Pattern and Function in Pregnancy-Induced Hypertension

BACKGROUND AND OBJECTIVES: Chronic hypertension induces changes in the cardiac structure and function; however, the effects of transient hypertension are unclear. Pregnancy-induced hypertension (PIH) offers a natural and spontaneous model of this condition. SUBJECTS AND METHODS: 20 women, aged 30.3+/-5.1 years, with pregnancy-induced hypertension, defined as a blood pressure higher than 140/90 mmHg in the third trimester of pregnancy, with no prior history of hypertension, were studied. 20 normal pregnant women (NPW), aged 30.9+/-3.7 years, were used as the controls. The cardiac chamber dimensions, interventricular septal thickness (IVST), posterior wall thickness (PWT), left ventricular mass index (LVMI), relative wall thickness (RWT), E velocity, A velocity, E/A ratio, isovolumetric relaxation time (IRT), isovolumetric contraction time (ICT), ejection time (ET) and the combined index of myocardial performance (Tei index=IRT+ICT/ET) were calculated by echocardiography. Subjects were considered to have: normal geometry (NG) if both the LVMI and RWT were normal; concentric hypertrophy (CH) if both were elevated; eccentric hypertrophy (EH) if the LVMI was elevated and the RWT normal; and concentric remodeling (CR) if the LVMI was normal and the RWT elevated. RESULTS: There were significant differences between the 2 groups in the following parameters; IVST: 10.5+/-1.3 mm in PIH vs. 8.6+/-1.0 mm in NPW (p<0.0001), PWT: 10.0+/-1.4 mm in PIH vs. 8.9+/-0.9 mm in NPW (p<0.005), LVMI: 113.1+/-20.3 g/m2 in PIH vs. 85.9+/-14.5 g/m2 in NPW (p<0.0001), RWT: 0.41+/-0.08 in PIH vs. 0.35+/-0.03 in NPW (p<0.005), E/A ratio: 0.95+/-0.29 in PIH vs. 1.56+/-0.27 in NPW (p<0.0001), IRT: 118.8+/-19.5 msec in PIH vs. 83.1+/-12.4 msec in NPW (p<0.0001) and the Tei index: 0.51+/-0.09 in PIH vs. 0.31+/-0.06 in NPW (p<0.0001). The geometric patterns of PIH women were NG in 4 (20%) and abnormal geometry in 16 (80%), of which 10 (50%) had EH. The geometric patterns of NPW were NG in 19 (95%) and abnormal geometry in 1 (5%), which also had EH. CONCLUSION: PIH increases the LVMI due to an increase in the IVST and PWT; the most frequent abnormal geometric pattern was EH. The dimensions of the left ventricle, left atrium and aortic root were unchanged. PIH showed left ventricular dysfunction, mainly diastolic. The IRT and Tei index are the most useful echocardiographic parameters to reveal left ventricular dysfunction in PIH.

Influence of Obesity on Left ventricular filling patterns in Hypertensives / 대한내과학회지

BACKGROUND: Left ventricular (LV) diastolic dysfunction has often been described in arterial hypertension in either the presence or the absence of LV hypertrophy. Impairment of LV relaxation have been recently described in obese normotensive individuals, and the prevalence of overweight to frank obesity in hypertensive populations is very high, obesity might well be an important confounder for the evaluation of LV diastolic dysfunction in the patients with hypertension. Accordingly, we designed this study to assess the effect of obesity on LV relaxation and filling in arterial hypertension. METHODS: We assessed the relations of left ventricular filling to load and geometry by Doppler echocardiography in 73 normotensive subjects (40 normal-weight [50 +/- 11 years, 22 women] and 33 obese [57 +/- 11 years, 27 women]) and 81 hypertensive subjects without silent coronary heart disease (23 normal-weight [59 +/- 7 years, 13 women] and 58 obese [54 +/- 13 years, 30 women]). RESULTS: Isovolumic relaxation time (IVRT) was prolonged in hypertensive subjects and normotensive obese subjects compared with normotensive normal-weight subjects (all p<0.01). After controlling for age, height, blood pressure, LV mass index, body mass index, between-group differences in IVRT, peak early transmitral flow velocity, the deceleration time (DT) of early filling velocity, and the ratio of early to late left ventricular filling were disappeared. CONCLUSION: Isovolumic relaxation time (IVRT) is prolonged in both arterial hypertension and obesity, and the presence of obesity does not significantly increase isovolumic relaxation time in hypertension, and abnormalities of left ventricular filling in arterial hypertension are offset after controlling for left ventricular mass.