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.
Key Words
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Article info
Publication history
Published online: July 31, 2020
Accepted:
July 7,
2020
Received in revised form:
May 21,
2020
Received:
February 12,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
