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.
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.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Cardiac Failure
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Abnormal left ventricular ejection fraction response to mental stress and exercise in cardiomyopathy.J Nucl Cardiol. 1995; 2: 144-150
- Role of behavioral and psychological factors in mental stress-induced silent left ventricular dysfunction in coronary artery disease.J Am Coll Cardiol. 1993; 22: 440-448
- The relation of psychosocial distress with myocardial perfusion and stress-induced myocardial ischemia.Psychosom Med. 2019; 81: 363-371
- Effects of mental exercise in patients with dilated cardiomyopathy and congestive heart failure. An echocardiographic Doppler study.. Circulation. 1991; 83: II155-II165
- Diastolic determinants of excess mortality in heart failure with reduced ejection fraction.JACC Heart Fail. 2019; 7: 808-817
- Prognostic utility of diastolic dysfunction and speckle tracking echocardiography in heart failure with reduced ejection fraction.ESC Heart Fai. 2020.; 7: 147-157
- High concordance between mental stress-induced and adenosine-induced myocardial ischemia assessed using SPECT in heart failure patients: hemodynamic and biomarker correlates.J Nucl Med. 2015; 56: 1527-1533
- Associations of perceived stress and state anger with symptom burden and functional status in patients with heart failure.Psychol Health. 2019; 34: 1250-1266
- A global measure of perceived stress.J Health Soc Behav. 1983; 24: 385-396
- The experience and expression of anger: construction and validation of an anger expression scale.in: Chesney Roseman Anger and hostility in cardiovascular and behavioral disorders. Hemisphere/McGraw-Hill, New York1985: 5-30
- Emotional style and susceptibility to the common cold.Psychosom Med. 2003; 65: 652-657
- Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.J Am Soc Echocardiogr. 2016; 29: 277-314
- Influence of age on assessment of diastolic function by doppler tissue imaging.Am J Cardiol. 2003; 91: 254-257
- Usefulness of myocardial annular velocity change during mental stress to predict cardiovascular outcome in patients with coronary artery disease (from the responses of mental stress-induced myocardial ischemia to escitalopram treatment trial).Am J Cardiol. 2017; 120: 1495-1500
- Trait anger and arterial stiffness: results from the atherosclerosis risk in communities (ARIC) study.Prev Cardiol. 2006; 9: 14-20
Published online: July 31, 2020
Accepted: July 7, 2020
Received in revised form: May 21, 2020
Received: February 12, 2020
© 2020 Elsevier Inc. All rights reserved.