Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine Graduate Programs in the Biomedical Sciences and Public Health

Abstract

.................................................................................................................................................. II GLOSSARY OF TERMS............................................................................................................................IV TABLE OF CONTENTS ............................................................................................................................. V INTRODUCTION ......................................................................................................................................... 1 SUDDEN CARDIAC DEATH.......................................................................................................................... 3 THE LETHAL TRIAD ................................................................................................................................... 4 Myocardial vulnerability. ...................................................................................................................... 6 Autonomic nervous system and SCD. ................................................................................................ 30 Myocardial substrate. .......................................................................................................................... 44 MENTAL STRESS....................................................................................................................................... 48 The stress response.............................................................................................................................. 48 Mental stress and CVD. ...................................................................................................................... 51 Mental stress in laboratory studies. .................................................................................................... 53 Summary.............................................................................................................................................. 60 Stress Response during Physical and Mental Challenges. ................................................................ 60 RELATIONSHIPS AMONG NON-INVASIVE MARKERS OF SUDDEN CARDIAC DEATH .............................. 64 RATIONALE FOR THE PROPOSED STUDY................................................................................................. 66 SPECIFIC AIMS ......................................................................................................................................... 68 METHODS................................................................................................................................................... 71 PARTICIPANTS .......................................................................................................................................... 71 STUDY PROCEDURE.................................................................................................................................. 72 Mental stress. ....................................................................................................................................... 73 MEASURES. ............................................................................................................................................... 75 ECG. .................................................................................................................................................... 75 T-wave alternans. ................................................................................................................................ 75 Heart rate variability. .......................................................................................................................... 79 Ischemia............................................................................................................................................... 80 Heart rate recovery.............................................................................................................................. 80 Ejection fraction. ................................................................................................................................. 81 POWER ANALYSES ................................................................................................................................... 82 STATISTICAL ANALYSES .......................................................................................................................... 83 RESULTS ..................................................................................................................................................... 87 SAMPLE CHARACTERISTICS .................................................................................................................... 87 INITIAL DATA EXAMINATION AND TRANSFORMATION .......................................................................... 87 T-wave alternans (TWA). .................................................................................................................... 88 Heart rate recovery (HRR).................................................................................................................. 90 Ejection fraction (EF), QT variability index (QTVI) and ischemia.................................................. 90 High frequency (HF) of heart rate variability (HRV). ...................................................................... 91 STUDY AIM AND HYPOTHESIS I ............................................................................................................... 92 MMA-TWA. ......................................................................................................................................... 92 Heart Rate Recovery (HRR). .............................................................................................................. 93 Myocardial Ischemia........................................................................................................................... 93 High Frequency (HF) of Heart Rate Variability (HRV). .................................................................. 94 STUDY AIM AND HYPOTHESES II ............................................................................................................ 94 Study Aim and Hypothesis II (a). ....................................................................................................... 94 Study Aim and Hypothesis II (b). ....................................................................................................... 96

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Cite this paper

@inproceedings{Haigney2011UniformedSU, title={Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine Graduate Programs in the Biomedical Sciences and Public Health}, author={Mark C.P. Haigney}, year={2011} }