Elsevier

Journal of Cardiac Failure

Volume 26, Issue 11, November 2020, Pages 1006-1010
Journal of Cardiac Failure

Brief Report
Impact of Mental Stress and Anger on Indices of Diastolic Function in Patients With Heart Failure

https://doi.org/10.1016/j.cardfail.2020.07.008Get rights and content

Abstract

Background

Under controlled conditions, mental stress can provoke decrements in ventricular function, yet little is known about the effect of mental stress on diastolic function in patients with heart failure (HF).

Methods and Results

Twenty-four patients with HF with ischemic cardiomyopathy and reduced ejection fraction (n = 23 men; mean left ventricular [LV] ejection fraction 27 ± 9%; n = 13 with baseline elevated E/e’) completed daily assessment of perceived stress, anger, and negative emotion for 7 days, followed by a laboratory mental stress protocol. Two-dimensional Doppler echocardiography was performed at rest and during sequential anger recall and mental arithmetic tasks to assess indices of diastolic function (E, e’, and E/e’). Fourteen patients (63.6%) experienced stress-induced increases in E/e', with an average baseline to stress change of 6.5 ± 9.3, driven primarily by decreases in early LV relaxation (e’). Age-adjusted linear regression revealed an association between 7-day anger and baseline E/e’; patients reporting greater anger in the week before mental stress exhibited higher resting LV diastolic pressure.

Conclusions

In patients with HF with reduced ejection fraction, mental stress can provoke acute worsening of LV diastolic pressure, and recent anger is associated with worse resting LV diastolic pressure. In patients vulnerable to these effects, repeated stress exposures or experiences of anger may have implications for long-term outcomes.

Section snippets

Participants

A subset of Biobehavioral Triggers in HF (BETRHEART) study participants7,8 with symptomatic HF (New York Heart Association functional class II–IV disease) for 3 or more months owing to ischemic cardiomyopathy, history of coronary artery disease, and LV ejection fraction (LVEF) of 40% or less within the past year were recruited from the University of Maryland Medical Center. Patients with myocarditis, significant mitral valve disease, current alcohol abuse, an LV assist device, in active cancer

Results

Thirty-five patients were enrolled. One patient remained hypertensive at rest and was withdrawn, ECHO was not obtained on 4 patients owing to body habitus, and 6 patients did not complete 1 or more daily psychological assessments, resulting in a sample size of 24. Excluded patients had a higher prevalence of anxiety disorders but did not differ from sample patients in other characteristics. The mean LVEF was 27 ± 9% and 13 (54.2%) patients exhibited baseline LV diastolic pressures indicative of

Discussion

This study demonstrates that, under controlled conditions, mental stress can provoke acute worsening of ventricular diastolic function in patients with HFrEF, and reports an association of recent anger with baseline LV diastolic pressure. Most patients, including those with and without evidence of resting diastolic dysfunction, experienced decreased early LV relaxation and increased LV diastolic pressure when exposed to mental stress. These patients also had higher systemic vascular resistance

Acknowledgments

Supported by National Heart Lung and Blood Institute grant R01HL085730.

The opinions and assertions expressed herein are those of the authors and are not necessarily those of the Uniformed Services University or the U.S. Department of Defense.

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