Brief ReportImpact of Mental Stress and Anger on Indices of Diastolic Function in Patients With Heart Failure
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 One patient remained hypertensive at rest and was withdrawn, ECHO was not obtained on 4 patients owing to body habitus, and 6 patients did not complete 1 or more daily psychological assessments, resulting in a sample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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