progress regarding the diagnosis and treatment of mental stress induced myocardial ischemia
Mental stress induced myocardial ischemia (MSIMI) is a transient myocardial ischemic response to mental stress (1) that can be induced in patients with coronary artery disease (CAD) during a standardized mental stress challenge (2) Notably, patients with CAD are more likely to develop MSIMI under the influence of factors, such as age, sex, and psychosocial characteristics, Several randomized controlled trials (RCTs) have proven that MSIMI can increase the incidence of adverse cardiovascular events (3) A study by Jiang et al. (4) enrolled patients with CAD with standardized mental stress and revealed that the incidence of MSIMI is as high as 30% 40% In addition, it has long been confirmed by Sheps et al. (5) that MSIMI has a twofold increased risk of a combined end point of cardiac events or total mortality. Furthermore, the large INTERHEART study performed comprehensive measurements of psychosocial distress and revealed that its attributable risk in women with acute myocardial infarction is 40% whereas that for men is only 25% (6) Sun et al. (7) demonstrated that the prevalence of MSIMI in patients with ischemic heart disease is as high as 70% Moreover, for every 5% decrease in left ventricular ejection fraction, the incidence of future adverse cardiovascular events increases by 20% within 6 years, and the risk of mortality associated with cardiac events is tripled. Notably, MSIMI not only affects the quality of life of patients but also leads to the deterioration of clinical prognosis and an increased risk of death. Based on recent RCTs, this paper summarizes the current status and progress of MSIMI research regarding the pathogenesis, diagnosis, and treatment strategies to provide a theoretical basis for the follow up diagnostic methods and treatment guidelines for MSIMI.