ArticleArteriosclerosis, thrombosis, and vascular biology2018
Sex Differences in Hemodynamic and Microvascular Mechanisms of Myocardial Ischemia Induced by Mental Stress.
Open access · bronzeAbstract readComparative Study
In one paragraph
Article in Arteriosclerosis, thrombosis, and vascular biology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 44 papers.
0numbers the graph read from it
0cells of the map it votes in
44citing papers in PubMed
4.1field-weighted citation impact, top 5% of its field
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
44 citing papers in PubMed, 61 citations in OpenAlex.
- Heart Rate Variability Biofeedback and Mental Stress Myocardial Flow Reserve: A Randomized Clinical Trial.JAMA network open · 2025Trial
- Sex Differences in Psychosocial Factors and Angina in Patients With Chronic Coronary Disease.Journal of the American Heart Association · 2025Trial
- Neighborhood poverty and hemodynamic, neuroendocrine, and immune response to acute stress among patients with coronary artery disease.Psychoneuroendocrinology · 2019Trial
- Mental Stress-Induced-Myocardial Ischemia in Young Patients With Recent Myocardial Infarction: Sex Differences and Mechanisms.Circulation · 2018Trial
- From protection to predisposition: A narrative review of sex-specific vascular responses to acute stressors across the lifespan.Physiological reports · 2026Review
- Anxiety and Depression in Women's Cardiovascular Health: Risk Modifiers, Mechanisms and Clinical Implications.Journal of cardiovascular development and disease · 2026Review
- Bidirectional brain-heart communication in coronary heart disease: from coronary plaques to central autonomic networks.Frontiers in neuroscience · 2026Review
- Cardiomyocyte Glucocorticoid Receptors Exacerbate Stress Effects in Myocardial Ischemia Injury in Mice.Cells · 2025Article
- Lifestyle medicine pillars for women's heart health.American journal of preventive cardiology · 2025Article
- Psychosocial stress and cardiovascular disease.American journal of preventive cardiology · 2025Review
- Myocardial blood flow mechanism of mental stress-induced myocardial ischemia in women with ANOCA.iScience · 2024Article
- Stress and cardiovascular disease: an update.Nature reviews. Cardiology · 2024Review
- The Role of Psychosocial Stress on Cardiovascular Disease in Women: JACC State-of-the-Art Review.Journal of the American College of Cardiology · 2024Review
- A multimodal physiological and psychological dataset for human with mental stress induced myocardial ischemia.Scientific data · 2024Article
- Heart-brain axis: Pushing the boundaries of cardiovascular molecular imaging.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2024Review
- Stress-Induced Autonomic Dysfunction is Associated With Mental Stress-Induced Myocardial Ischemia in Patients With Coronary Artery Disease.Circulation. Cardiovascular imaging · 2024Article
- Association Between Symptoms of Chronic Psychological Distress and Myocardial Ischemia Induced by Mental Stress in Patients With Coronary Artery Disease.Journal of the American Heart Association · 2023Article
- Quantitation of diffuse myocardial ischemia with mental stress and its association with cardiovascular events in individuals with recent myocardial infarction.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2023Article
- A Pilot Study of Neurobiological Mechanisms of Stress and Cardiovascular Risk.Medical research archives · 2023Article
- Sex Differences in Vascular Response to Mental Stress and Adverse Cardiovascular Events Among Patients With Ischemic Heart Disease.Arteriosclerosis, thrombosis, and vascular biology · 2023Article
Corrections and comments
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Authors and funding
20 authors at 3 institutions in 2 countries.
Samaah SullivanFrom the Department of Epidemiology (S.S., A.S., P.M.P., T.T.L., V.V.) and Department of Biostatistics and Bioinformatics (M.K., L.W.), Rollins School of Public Health, Emory University, Atlanta, GA; Atlanta Veterans Affairs Medical Center, Decatur, GA (A.S., J.D.B.); Department of Psychiatry and Behavioral Sciences (J.D.B.), Department of Radiology (E.V.G., J.N.), and Department of Medicine, Division of Cardiology (M.H., I.A.M., K.W., R.R., A.A., N.I., A.S., O.L., P.K.M., A.A.Q., V.V.), Emory University School of Medicine, Atlanta, GA; and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (P.R.).
Muhammad HammadahFrom the Department of Epidemiology (S.S., A.S., P.M.P., T.T.L., V.V.) and Department of Biostatistics and Bioinformatics (M.K., L.W.), Rollins School of Public Health, Emory University, Atlanta, GA; Atlanta Veterans Affairs Medical Center, Decatur, GA (A.S., J.D.B.); Department of Psychiatry and Behavioral Sciences (J.D.B.), Department of Radiology (E.V.G., J.N.), and Department of Medicine, Division of Cardiology (M.H., I.A.M., K.W., R.R., A.A., N.I., A.S., O.L., P.K.M., A.A.Q., V.V.), Emory University School of Medicine, Atlanta, GA; and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (P.R.).
Ibhar Al MheidFrom the Department of Epidemiology (S.S., A.S., P.M.P., T.T.L., V.V.) and Department of Biostatistics and Bioinformatics (M.K., L.W.), Rollins School of Public Health, Emory University, Atlanta, GA; Atlanta Veterans Affairs Medical Center, Decatur, GA (A.S., J.D.B.); Department of Psychiatry and Behavioral Sciences (J.D.B.), Department of Radiology (E.V.G., J.N.), and Department of Medicine, Division of Cardiology (M.H., I.A.M., K.W., R.R., A.A., N.I., A.S., O.L., P.K.M., A.A.Q., V.V.), Emory University School of Medicine, Atlanta, GA; and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (P.R.).
Kobina WilmotFrom the Department of Epidemiology (S.S., A.S., P.M.P., T.T.L., V.V.) and Department of Biostatistics and Bioinformatics (M.K., L.W.), Rollins School of Public Health, Emory University, Atlanta, GA; Atlanta Veterans Affairs Medical Center, Decatur, GA (A.S., J.D.B.); Department of Psychiatry and Behavioral Sciences (J.D.B.), Department of Radiology (E.V.G., J.N.), and Department of Medicine, Division of Cardiology (M.H., I.A.M., K.W., R.R., A.A., N.I., A.S., O.L., P.K.M., A.A.Q., V.V.), Emory University School of Medicine, Atlanta, GA; and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (P.R.).
Ronnie RamadanFrom the Department of Epidemiology (S.S., A.S., P.M.P., T.T.L., V.V.) and Department of Biostatistics and Bioinformatics (M.K., L.W.), Rollins School of Public Health, Emory University, Atlanta, GA; Atlanta Veterans Affairs Medical Center, Decatur, GA (A.S., J.D.B.); Department of Psychiatry and Behavioral Sciences (J.D.B.), Department of Radiology (E.V.G., J.N.), and Department of Medicine, Division of Cardiology (M.H., I.A.M., K.W., R.R., A.A., N.I., A.S., O.L., P.K.M., A.A.Q., V.V.), Emory University School of Medicine, Atlanta, GA; and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (P.R.).
Ayman AlkhoderFrom the Department of Epidemiology (S.S., A.S., P.M.P., T.T.L., V.V.) and Department of Biostatistics and Bioinformatics (M.K., L.W.), Rollins School of Public Health, Emory University, Atlanta, GA; Atlanta Veterans Affairs Medical Center, Decatur, GA (A.S., J.D.B.); Department of Psychiatry and Behavioral Sciences (J.D.B.), Department of Radiology (E.V.G., J.N.), and Department of Medicine, Division of Cardiology (M.H., I.A.M., K.W., R.R., A.A., N.I., A.S., O.L., P.K.M., A.A.Q., V.V.), Emory University School of Medicine, Atlanta, GA; and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (P.R.).
Nino IsakadzeFrom the Department of Epidemiology (S.S., A.S., P.M.P., T.T.L., V.V.) and Department of Biostatistics and Bioinformatics (M.K., L.W.), Rollins School of Public Health, Emory University, Atlanta, GA; Atlanta Veterans Affairs Medical Center, Decatur, GA (A.S., J.D.B.); Department of Psychiatry and Behavioral Sciences (J.D.B.), Department of Radiology (E.V.G., J.N.), and Department of Medicine, Division of Cardiology (M.H., I.A.M., K.W., R.R., A.A., N.I., A.S., O.L., P.K.M., A.A.Q., V.V.), Emory University School of Medicine, Atlanta, GA; and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (P.R.).
Amit ShahFrom the Department of Epidemiology (S.S., A.S., P.M.P., T.T.L., V.V.) and Department of Biostatistics and Bioinformatics (M.K., L.W.), Rollins School of Public Health, Emory University, Atlanta, GA; Atlanta Veterans Affairs Medical Center, Decatur, GA (A.S., J.D.B.); Department of Psychiatry and Behavioral Sciences (J.D.B.), Department of Radiology (E.V.G., J.N.), and Department of Medicine, Division of Cardiology (M.H., I.A.M., K.W., R.R., A.A., N.I., A.S., O.L., P.K.M., A.A.Q., V.V.), Emory University School of Medicine, Atlanta, GA; and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (P.R.).
Oleksiy LevantsevychFrom the Department of Epidemiology (S.S., A.S., P.M.P., T.T.L., V.V.) and Department of Biostatistics and Bioinformatics (M.K., L.W.), Rollins School of Public Health, Emory University, Atlanta, GA; Atlanta Veterans Affairs Medical Center, Decatur, GA (A.S., J.D.B.); Department of Psychiatry and Behavioral Sciences (J.D.B.), Department of Radiology (E.V.G., J.N.), and Department of Medicine, Division of Cardiology (M.H., I.A.M., K.W., R.R., A.A., N.I., A.S., O.L., P.K.M., A.A.Q., V.V.), Emory University School of Medicine, Atlanta, GA; and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (P.R.).
Pratik M PimpleFrom the Department of Epidemiology (S.S., A.S., P.M.P., T.T.L., V.V.) and Department of Biostatistics and Bioinformatics (M.K., L.W.), Rollins School of Public Health, Emory University, Atlanta, GA; Atlanta Veterans Affairs Medical Center, Decatur, GA (A.S., J.D.B.); Department of Psychiatry and Behavioral Sciences (J.D.B.), Department of Radiology (E.V.G., J.N.), and Department of Medicine, Division of Cardiology (M.H., I.A.M., K.W., R.R., A.A., N.I., A.S., O.L., P.K.M., A.A.Q., V.V.), Emory University School of Medicine, Atlanta, GA; and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (P.R.).
Michael KutnerFrom the Department of Epidemiology (S.S., A.S., P.M.P., T.T.L., V.V.) and Department of Biostatistics and Bioinformatics (M.K., L.W.), Rollins School of Public Health, Emory University, Atlanta, GA; Atlanta Veterans Affairs Medical Center, Decatur, GA (A.S., J.D.B.); Department of Psychiatry and Behavioral Sciences (J.D.B.), Department of Radiology (E.V.G., J.N.), and Department of Medicine, Division of Cardiology (M.H., I.A.M., K.W., R.R., A.A., N.I., A.S., O.L., P.K.M., A.A.Q., V.V.), Emory University School of Medicine, Atlanta, GA; and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (P.R.).
Laura WardFrom the Department of Epidemiology (S.S., A.S., P.M.P., T.T.L., V.V.) and Department of Biostatistics and Bioinformatics (M.K., L.W.), Rollins School of Public Health, Emory University, Atlanta, GA; Atlanta Veterans Affairs Medical Center, Decatur, GA (A.S., J.D.B.); Department of Psychiatry and Behavioral Sciences (J.D.B.), Department of Radiology (E.V.G., J.N.), and Department of Medicine, Division of Cardiology (M.H., I.A.M., K.W., R.R., A.A., N.I., A.S., O.L., P.K.M., A.A.Q., V.V.), Emory University School of Medicine, Atlanta, GA; and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (P.R.).
Ernest V GarciaFrom the Department of Epidemiology (S.S., A.S., P.M.P., T.T.L., V.V.) and Department of Biostatistics and Bioinformatics (M.K., L.W.), Rollins School of Public Health, Emory University, Atlanta, GA; Atlanta Veterans Affairs Medical Center, Decatur, GA (A.S., J.D.B.); Department of Psychiatry and Behavioral Sciences (J.D.B.), Department of Radiology (E.V.G., J.N.), and Department of Medicine, Division of Cardiology (M.H., I.A.M., K.W., R.R., A.A., N.I., A.S., O.L., P.K.M., A.A.Q., V.V.), Emory University School of Medicine, Atlanta, GA; and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (P.R.).
Jonathon NyeFrom the Department of Epidemiology (S.S., A.S., P.M.P., T.T.L., V.V.) and Department of Biostatistics and Bioinformatics (M.K., L.W.), Rollins School of Public Health, Emory University, Atlanta, GA; Atlanta Veterans Affairs Medical Center, Decatur, GA (A.S., J.D.B.); Department of Psychiatry and Behavioral Sciences (J.D.B.), Department of Radiology (E.V.G., J.N.), and Department of Medicine, Division of Cardiology (M.H., I.A.M., K.W., R.R., A.A., N.I., A.S., O.L., P.K.M., A.A.Q., V.V.), Emory University School of Medicine, Atlanta, GA; and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (P.R.).
Puja K MehtaFrom the Department of Epidemiology (S.S., A.S., P.M.P., T.T.L., V.V.) and Department of Biostatistics and Bioinformatics (M.K., L.W.), Rollins School of Public Health, Emory University, Atlanta, GA; Atlanta Veterans Affairs Medical Center, Decatur, GA (A.S., J.D.B.); Department of Psychiatry and Behavioral Sciences (J.D.B.), Department of Radiology (E.V.G., J.N.), and Department of Medicine, Division of Cardiology (M.H., I.A.M., K.W., R.R., A.A., N.I., A.S., O.L., P.K.M., A.A.Q., V.V.), Emory University School of Medicine, Atlanta, GA; and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (P.R.).
Tené T LewisFrom the Department of Epidemiology (S.S., A.S., P.M.P., T.T.L., V.V.) and Department of Biostatistics and Bioinformatics (M.K., L.W.), Rollins School of Public Health, Emory University, Atlanta, GA; Atlanta Veterans Affairs Medical Center, Decatur, GA (A.S., J.D.B.); Department of Psychiatry and Behavioral Sciences (J.D.B.), Department of Radiology (E.V.G., J.N.), and Department of Medicine, Division of Cardiology (M.H., I.A.M., K.W., R.R., A.A., N.I., A.S., O.L., P.K.M., A.A.Q., V.V.), Emory University School of Medicine, Atlanta, GA; and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (P.R.).
J Douglas BremnerFrom the Department of Epidemiology (S.S., A.S., P.M.P., T.T.L., V.V.) and Department of Biostatistics and Bioinformatics (M.K., L.W.), Rollins School of Public Health, Emory University, Atlanta, GA; Atlanta Veterans Affairs Medical Center, Decatur, GA (A.S., J.D.B.); Department of Psychiatry and Behavioral Sciences (J.D.B.), Department of Radiology (E.V.G., J.N.), and Department of Medicine, Division of Cardiology (M.H., I.A.M., K.W., R.R., A.A., N.I., A.S., O.L., P.K.M., A.A.Q., V.V.), Emory University School of Medicine, Atlanta, GA; and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (P.R.).
Paolo RaggiFrom the Department of Epidemiology (S.S., A.S., P.M.P., T.T.L., V.V.) and Department of Biostatistics and Bioinformatics (M.K., L.W.), Rollins School of Public Health, Emory University, Atlanta, GA; Atlanta Veterans Affairs Medical Center, Decatur, GA (A.S., J.D.B.); Department of Psychiatry and Behavioral Sciences (J.D.B.), Department of Radiology (E.V.G., J.N.), and Department of Medicine, Division of Cardiology (M.H., I.A.M., K.W., R.R., A.A., N.I., A.S., O.L., P.K.M., A.A.Q., V.V.), Emory University School of Medicine, Atlanta, GA; and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (P.R.).
Arshed A QuyyumiFrom the Department of Epidemiology (S.S., A.S., P.M.P., T.T.L., V.V.) and Department of Biostatistics and Bioinformatics (M.K., L.W.), Rollins School of Public Health, Emory University, Atlanta, GA; Atlanta Veterans Affairs Medical Center, Decatur, GA (A.S., J.D.B.); Department of Psychiatry and Behavioral Sciences (J.D.B.), Department of Radiology (E.V.G., J.N.), and Department of Medicine, Division of Cardiology (M.H., I.A.M., K.W., R.R., A.A., N.I., A.S., O.L., P.K.M., A.A.Q., V.V.), Emory University School of Medicine, Atlanta, GA; and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (P.R.).
Viola VaccarinoFrom the Department of Epidemiology (S.S., A.S., P.M.P., T.T.L., V.V.) and Department of Biostatistics and Bioinformatics (M.K., L.W.), Rollins School of Public Health, Emory University, Atlanta, GA; Atlanta Veterans Affairs Medical Center, Decatur, GA (A.S., J.D.B.); Department of Psychiatry and Behavioral Sciences (J.D.B.), Department of Radiology (E.V.G., J.N.), and Department of Medicine, Division of Cardiology (M.H., I.A.M., K.W., R.R., A.A., N.I., A.S., O.L., P.K.M., A.A.Q., V.V.), Emory University School of Medicine, Atlanta, GA; and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (P.R.). viola.vaccarino@emory.edu.
University of Alberta · CAVeterans Health Administration · USEmory University · US
Funding
Implementing a Maternal health and PRegnancy Outcomes Vision for Everyone (IMPROVE)UL1TR002378 · NCATS · EMORY UNIVERSITY · PI Andres J Garcia, Elizabeth O. Ofili · 2017 to 2026
$92.1MAtlanta Clinical and Translational Science Institute (ACTSI) RenewalUL1TR000454 · NCATS · EMORY UNIVERSITY · PI STEPHENS, DAVID S · 2012 to 2016
$25.8MSerious Hazards of Transfusion & Cellular Therapies: Mechanisms and InterventionP01HL086773 · NHLBI · EMORY UNIVERSITY · PI JONES, DEAN PAUL · 2008 to 2019
$17.9MNeuro HPA Project 1U54AG062334 · NIA · EMORY UNIVERSITY · PI Cecile Delille Lahiri, Vasiliki Michopoulos · 2018 to 2026
$12.2MVascular Responses During Mental StressP01HL101398 · NHLBI · EMORY UNIVERSITY · PI QUYYUMI, ARSHED A · 2010 to 2015
$11.0MMental Stress and Myocardial Ischemia after MI: Sex Differences, Mechanisms and PrognosisR01HL109413 · NHLBI · EMORY UNIVERSITY · PI VACCARINO, VIOLA · 2012 to 2023
$6.9MMultidisciplinary Research Training to Reduce Inequities in Cardiovascular HealthT32HL130025 · NHLBI · EMORY UNIVERSITY · PI Tené T Lewis, Viola Vaccarino · 2016 to 2026
$6.4MNeural Circuits in Women with Abuse and PTSDR01MH056120 · NIMH · YALE UNIVERSITY · PI BREMNER, JAMES DOUGLAS · 1999 to 2011
$5.0MMechanisms Linking Depression to Cardiovascular RiskR01HL068630 · NHLBI · EMORY UNIVERSITY · PI VACCARINO, VIOLA · 2001 to 2010
$4.8MMetabolomics of subclinical and clinical cardiovascular diseaseP20HL113451 · NHLBI · EMORY UNIVERSITY · PI JONES, DEAN PAUL · 2012 to 2016
$4.3MPTSD and Ischemic Heart Disease Progression: A Longitudinal Twin StudyR01HL125246 · NHLBI · EMORY UNIVERSITY · PI VACCARINO, VIOLA · 2015 to 2018
$3.4MAtlanta Clinical and Translational Science Institute (ACTSI) RenewalKL2TR000455 · NCATS · EMORY UNIVERSITY · PI STEPHENS, DAVID S · 2012 to 2016
$2.9MNCATS NIH HHS KL2 TR000455NCATS NIH HHS UL1 TR000454NCATS NIH HHS UL1 TR002378NHLBI NIH HHS K23 HL127251NHLBI NIH HHS K24 HL077506NHLBI NIH HHS P01 HL086773NHLBI NIH HHS P01 HL101398NHLBI NIH HHS P20 HL113451NHLBI NIH HHS R01 HL068630NHLBI NIH HHS R01 HL088726NHLBI NIH HHS R01 HL109413NHLBI NIH HHS R01 HL125246NHLBI NIH HHS R56 HL126558NHLBI NIH HHS T32 HL130025NIAID NIH HHS R38 AI140299NIA NIH HHS R01 AG026255NIA NIH HHS U54 AG062334NIMH NIH HHS K24 MH076955NIMH NIH HHS R01 MH056120
Abstract
objectiveTo investigate sex-specific vascular mechanisms for mental stress-induced myocardial ischemia (MSIMI). APPROACH AND
resultsBaseline data from a prospective cohort study of 678 patients with coronary artery disease underwent myocardial perfusion imaging before and during a public speaking stressor. The rate-pressure product response was calculated as the difference between the maximum value during the speech minus the minimum value during rest. Peripheral vasoconstriction by peripheral arterial tonometry was calculated as the ratio of pulse wave amplitude during the speech over the resting baseline; ratios <1 indicate a vasoconstrictive response. MSIMI was defined as percent of left ventricle that was ischemic and as a dichotomous variable. Men (but not women) with MSIMI had a higher rate-pressure product response than those without MSIMI (6500 versus 4800 mm Hg bpm), whereas women (but not men) with MSIMI had a significantly lower peripheral arterial tonometry ratio than those without MSIMI (0.5 versus 0.8). In adjusted linear regression, each 1000-U increase in rate-pressure product response was associated with 0.32% (95% confidence interval, 0.22-0.42) increase in inducible ischemia among men, whereas each 0.10-U decrease in peripheral arterial tonometry ratio was associated with 0.23% (95% confidence interval, 0.11-0.35) increase in inducible myocardial ischemia among women. Results were independent of conventional stress-induced myocardial ischemia.
conclusionsWomen and men have distinct cardiovascular reactivity mechanisms for MSIMI. For women, stress-induced peripheral vasoconstriction with mental stress, and not increased hemodynamic workload, is associated with MSIMI, whereas for men, it is the opposite. Future studies should examine these pathways on long-term outcomes.
Indexed as
Coronary CirculationHemodynamicsMicrocirculationAdultAgedBlood PressureFemaleFingersHeart RateHumansMaleManometryMiddle AgedMyocardial IschemiaMyocardial Perfusion ImagingProspective Studiesarterieshemodynamicshumansmyocardial ischemiavasoconstriction
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