TY - JOUR
T1 - Low hot pain threshold predicts shorter time to exercise-induced angina
T2 - Results from the psychophysiological investigations of myocardial ischemia (PIMI) study
AU - Sheps, David S.
AU - McMahon, Robert P.
AU - Light, Kathleen C.
AU - Maixner, William
AU - Pepine, Carl J.
AU - Cohen, Jerome D.
AU - Goldberg, A. David
AU - Bonsall, Robert
AU - Carney, Robert
AU - Stone, Peter H.
AU - Sheffield, David
AU - Kaufmann, Peter G.
N1 - Funding Information:
The Psychophysiological Investigations of Myocardial Ischemia (PIMI) was supported by contracts HV 18114, HV 18119–HV 18121 and HV 28127 from the National Heart, Lung, and Blood Institute. Support for electrocardiogram data collection was provided in part by Applied Cardiac Systems, Laguna Hills, California; Marquette Electronics, Milwaukee, Wisconsin; Quinton Instruments, Seattle, Washington, and Mortara Instruments, Milwaukee, Wisconsin. Dinamap equipment was provided by Critikon, Inc., a Johnson and Johnson Company. Michael Eddy, University of Pittsburgh, and Richard Lutz, University of North Carolina provided Stroop Test software. Dr. Kathleen Light provided role play scenarios for the speech task. Some centers had partial support from General Clinical Research Center grants. A list of participating centers and investigators appears in Kaufmann et al. (1998) (12) . The opinions and assertions contained herein are those of the authors and should not be construed as representing positions or policies of the National Heart, Lung, and Blood Institute or the U.S. Department of Health and Human Services.
PY - 1999/6
Y1 - 1999/6
N2 - OBJECTIVES: The purpose of this study was to test whether cutaneous thermal pain thresholds are related to anginal pain perception. BACKGROUND: Few ischemic episodes are associated with angina; symptoms have been related to pain perception thresholds. METHODS:: A total of 196 patients with documented coronary artery disease underwent bicycle exercise testing and thermal pain testing. The Marstock test of cutaneous sensory perception was administered at baseline after 30 min of rest on two days and after exercise and mental stress. Resting hot pain thresholds (HPTs) were averaged for the two baseline visits and divided into two groups: 1) average HPT <41°C, and 2) average HPT ≥41°C, to be clearly indicative of abnormal hypersensitivity to noxious heat. RESULTS:: Patients with HPT <41°C had significantly shorter time to angina onset on exercise testing than patients with HPT ≥41°C (p < 0.04, log-rank test). Heart rates, systolic blood pressure and rate-pressure product at peak exercise were not different for the two groups. Resting plasma beta-endorphin levels were significantly higher in the HPT <41°C group (5.9 ± 3.7 pmol/liter vs. 4.7 ± 2.8 pmol/liter, p = 0.02). Using a Cox proportional hazards model, patients with HPT <41°C had an increased risk of angina (p = 0.03, rate ratio = 2.0). These differences persisted after adjustment for age, gender, depression, anxiety and history of diabetes or hypertension (p < 0.01). CONCLUSIONS:: Occurrence of angina and timing of angina onset on an exercise test are related to overall hot pain sensory perception. The mechanism of this relationship requires further study.
AB - OBJECTIVES: The purpose of this study was to test whether cutaneous thermal pain thresholds are related to anginal pain perception. BACKGROUND: Few ischemic episodes are associated with angina; symptoms have been related to pain perception thresholds. METHODS:: A total of 196 patients with documented coronary artery disease underwent bicycle exercise testing and thermal pain testing. The Marstock test of cutaneous sensory perception was administered at baseline after 30 min of rest on two days and after exercise and mental stress. Resting hot pain thresholds (HPTs) were averaged for the two baseline visits and divided into two groups: 1) average HPT <41°C, and 2) average HPT ≥41°C, to be clearly indicative of abnormal hypersensitivity to noxious heat. RESULTS:: Patients with HPT <41°C had significantly shorter time to angina onset on exercise testing than patients with HPT ≥41°C (p < 0.04, log-rank test). Heart rates, systolic blood pressure and rate-pressure product at peak exercise were not different for the two groups. Resting plasma beta-endorphin levels were significantly higher in the HPT <41°C group (5.9 ± 3.7 pmol/liter vs. 4.7 ± 2.8 pmol/liter, p = 0.02). Using a Cox proportional hazards model, patients with HPT <41°C had an increased risk of angina (p = 0.03, rate ratio = 2.0). These differences persisted after adjustment for age, gender, depression, anxiety and history of diabetes or hypertension (p < 0.01). CONCLUSIONS:: Occurrence of angina and timing of angina onset on an exercise test are related to overall hot pain sensory perception. The mechanism of this relationship requires further study.
UR - http://www.scopus.com/inward/record.url?scp=0032741002&partnerID=8YFLogxK
U2 - 10.1016/S0735-1097(99)00099-6
DO - 10.1016/S0735-1097(99)00099-6
M3 - Article
C2 - 10362185
AN - SCOPUS:0032741002
SN - 0735-1097
VL - 33
SP - 1855
EP - 1862
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 7
ER -