Abstract 18264: Heart Rate Variability Predicts Mental Stress Ischemia in Patients With Stable Coronary Artery Disease
Bibliographic record
Abstract
Introduction: Mental stress ischemia (MSI) is an independent risk factor for cardiovascular outcomes and death in CAD patients, but little is known about the mechanisms behind this phenomenon. We hypothesized that alterations in autonomic function before, during, or after mental stress may play a role. We examined whether MSI positive patients with CAD have reduced parasympathetic (PNS) tone, as measured by high frequency heart rate variability (HF HRV), as well as reduced baroreceptor sensitivity (BRS), as approximated by low frequency (LF) HRV at baseline, peak mental stress, and recovery. Methods: A mental stress test with a standardized speech stressor was performed in 425 CAD patients wearing an ambulatory ECG monitor. Myocardial perfusion imaging was performed with TC-99m Sestamibi. After careful editing for artifacts and ectopic beats, HF HRV and LF HRV were measured for 5-min periods during a baseline rest period, 5 min of speech, and 5 min of recovery. Logistic regression was used to adjust for potential confounders. Results: The mean (SD) age was 63 (9) years, 26% were women, and 30% were African American; 42 (10%) patients developed MSI. Compared with MSI negative, MSI positive patients had lower HF HRV and LF HRV during rest, stress, and recovery. The largest difference was observed during stress; HF HRV was 46% lower (p=0.01), and LF HRV was 44% lower (p=0.01). When examining reactivity to stress (difference between stress and rest), only LF HRV was significantly different between groups, such that MSI positive patients had an average 32% reduction in LF HRV with stress, while MSI negative patients had an average 3% increase (p=0.04). LF HRV reactivity remained an independent predictor of MSI (p=0.01) in models adjusting for sociodemographics, traditional risk factors, antidepressants, beta-blocker use, revascularization history, heart failure, depression, posttraumatic stress disorder, and heart rate/blood pressure reactivity. Conclusions: Autonomic factors, most notably reduced LF HRV reactivity, predict MSI in CAD patients. This implies reduced BRS and autonomic inflexibility as an important pathophysiological component of the ischemic response to mental stress.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".