Association of Posttraumatic Stress Disorder With Mental Stress–Induced Myocardial Ischemia in Adults After Myocardial Infarction

Abstract

IMPORTANCE Posttraumatic stress disorder (PTSD) is prevalent among patients who survived an acute coronary syndrome and is associated with adverse outcomes, but the mechanisms underlying these associations are unclear. OBJECTIVE To evaluate the association of PTSD with mental stress-induced myocardial ischemia among individuals who survived a myocardial infarction (MI). DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included 303 patients aged 18 to 60 years enrolled from a university-affiliated network. Participants had a verified history of MI within 8 months. Data were collected from June 2011 to March 2016, and data analysis was conducted from March to June 2019. EXPOSURES A clinical diagnosis of PTSD (lifetime and current) was obtained using the Structured Clinical Interview from the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition), and PTSD symptom subscales were assessed with the civilian version of the PTSD Symptom Checklist. MAIN OUTCOMES AND MEASURES Patients received technetium 99m-labeled sestamibi myocardial perfusion imaging at rest, with mental stress (ie, a speech task) and conventional stress (ie, exercise or pharmacologic). A summed difference score (ie, the difference between stress and rest scores) was used to assess ischemia under both stress conditions. RESULTS Among 303 participants (148 [48.8%] women; 198 [65.3%] African American; mean [SD] age, 51 [7] years), the prevalence of PTSD was 14.5% (44 patients). Patients with PTSD had a higher rate of ischemia with mental stress than those without PTSD (12 of 44 [27.3%] vs 38 of 259 [14.7%];

Assessment of trimethylamine N-oxide (TMAO) as a potential biomarker of severe stress in patients vulnerable to posttraumatic stress disorder (PTSD) after acute myocardial infarction

“…In addition, TMAO showed a minor trend for the prediction of the PTSD symptom subcluster re-experiencing. The observation that the re-experiencing subcluster is particularly strongly reflected in biomarkers is also supported by two studies: Lima et al ( 2020 ) investigated the association of AMI-related PTSD with mental stress-induced myocardial ischaemia among patients who survived AMI. In the study by Lima et al ( 2020 ), the PTSD symptom-subcluster re-experiencing was most strongly associated with ischaemia during mental stress after AMI (Lima et al, 2020 ).…”

“…The observation that the re-experiencing subcluster is particularly strongly reflected in biomarkers is also supported by two studies: Lima et al ( 2020 ) investigated the association of AMI-related PTSD with mental stress-induced myocardial ischaemia among patients who survived AMI. In the study by Lima et al ( 2020 ), the PTSD symptom-subcluster re-experiencing was most strongly associated with ischaemia during mental stress after AMI (Lima et al, 2020 ). Lima et al further suggested that AMI survivors with comorbid PTSD might also have a more pronounced inflammatory response to subsequent acute psychological stress situations than AMI survivors without comorbid PTSD.…”

The Mediating Role of Hope in the Relationship Between Perceived Stress and Post-Traumatic Stress Disorder Among Chinese Patients with Oral Cancer: A Cross-Sectional Study

“…Specifically, perceived stress was found to be positively related to PTSD symptoms, which echoes the findings of similar studies. 38–40 The potential stress of cancer patients is widely acknowledged since a cancer diagnosis is a stressful event for most individuals. 1 In addition to the overload of physiological stress caused by the cancer and its treatment, many patients experience mental stress, such as worries about their prognosis and treatments, disruption of their ordinary life functions and an uncertain survival time.…”

Application of Noninvasive Vagal Nerve Stimulation to Stress-Related Psychiatric Disorders

“…Increases in IL-6 and IFN-γ likely occur multiple times a day with minor stressors and triggers in PTSD patients, so tcVNS could result in a decrease in symptoms driven by inflammation and lead to improvements in clinical course. The reduction in subjective anger, in addition to improved mental health, also likely have beneficial health effects, for instance, in patients with comorbid PTSD and coronary artery disease (CAD), where we found not only an increase in mental stress-induced IL-6 in those with comorbid PTSD [ 63 ], but also that anger, PTSD, and other symptoms of psychological distress were associated with long-term adverse cardiovascular outcomes [ 296 ] and an increase in mental stress-induced myocardial ischemia [ 297 , 298 ].…”