Facial emotion expression and psychological background factors as related to the inducibility of myocardial ischemia during cardiac stress testing

Objective: 
Negative emotional states, such as anger and anxiety, are associated with the onset of myocardial infarction and other acute clinical manifestations of ischemic heart disease. The likelihood of experiencing these short-term negative emotions has been associated with long-term psychological background factors such as depression, generalized anxiety, and personality factors. We examined the
association of acute emotional states preceding cardiac stress testing (CST) with inducibility of myocardial ischemia and to what extent psychological background factors account for this association.

Methods: 
Emotional states were assessed in patients undergoing CST (N=210; mean age 66.9 years (standard deviation (±) =8.2 years); 43% women) using self-report measures and video recordings of facial emotion expression. Video recordings were analyzed for expressed anxiety, anger, sadness, and happiness prior to CST.
Psychological background factors were assessed with validated
questionnaires. Inducibility of ischemia was determined by singlephoton emission computed tomography (spect). Data were analyzed using bivariate and multivariate logistic regression analyses and the strength of associations expressed as odds ratios (OR) with 95% confidence intervals.
Results: Ischemia occurred in 72 (34%) patients. Emotional states were not associated with subsequent inducibility of ischemia during CST (OR between 0.93 and 1.04; p-values >0.50). Psychological background factors were also not associated with ischemia (OR between 0.96 and 1.06 per scale unit; p values >0.20), and did not account for the associations of emotional states with ischemia.

Conclusions: 
Emotional states immediately before CST and psychological background factors were not associated with the inducibility of ischemia. These findings indicate that the well documented association between negative emotions with acute clinical manifestations of ischemic heart disease requires a different explanation than a reduced threshold for inducible ischemia.