Facial expressions of emotions during pharmacological and exercise stress testing:The role of myocardial ischemia and cardiac symptoms

Background  Negative emotions have been linked to ischemic heart disease, but existing research typically involves self-report methods and little is known about non-verbal facial emotion expression. The role of ischemia and anginal symptoms in emotion expression was examined.  Methods  Patients undergoing cardiac stress testing (CST) using bicycle exercise or adenosine with myocardial perfusion imaging were included (N = 256, mean age 66.8 +/- 8.7 year., 43% women). Video images and emotion expression (sadness, anxiety, anger, and happiness) were analyzed at baseline, initial CST , maximal CST, recovery. Nuclear images were evaluated using SPECT.  Results  Ischemia (N = 89; 35%) was associated with higher levels of sadness (p = .017, d = 0.34) and lower happiness (p = .015, d = 0.30). During recovery, patients with both ischemia and anginal symptoms had the highest sadness expression (F (3,254) = 3.67, p = .013, eta(2) = 0.042) and the lowest happiness expression (F (3, 254) = 4.19, p = .006, eta(2) = .048).  Conclusion  Sadness and reduced happiness were more common in patients with ischemia. Also, anginal symptoms were associated with more negative emotions

Improved myocardial perfusion preceding clinical response on bosentan treatment for coronary vasospasm.

Many patients suffer from persistent angina due to coronary vasospasm despite optimal medical treatment. We treated a 46-year-old patient with severe and treatment-resistant coronary vasospasm with the endothelin-receptor antagonist bosentan. Using oxygen-15-labelled water in conjunction with oxygen 15-labelled carbon monoxide positron emission tomography (PET), we measured an impaired coronary flow reserve (CFR) in 6 out of 13 segments directly before the start of bosentan therapy. A repeated PET measurement after 16 weeks of bosentan revealed a completely normalized CFR in this patient. Furthermore, the patient reported less frequent and less severe chest pain. Our data suggest a potential role of endothelin-receptor antagonists for patients with severe coronary vasospasms

Facial emotion expression and the inducibility of myocardial ischemia during Cardiac stress testing: The role of psychological background factors

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 [standard deviation] age = 66.9 [8.2] years); 91 (43%) women) using self-report measures and video recordings of facial emotion expression. Video recordings were analyzed for expressed anxiety, anger, sadness, and happiness before CST. Psychological background factors were assessed with validated questionnaires. Single-photon emission computed tomography was used to evaluate inducibility of ischemia. Results Ischemia occurred in 72 patients (34%). Emotional states were not associated with subsequent inducibility of ischemia during CST (odds ratio between 0.93 and 1.04; p values > .50). Psychological background factors were also not associated with ischemia (odds ratio between 0.96 and 1.06 per scale unit; p values > .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

Facial expressions of emotions during pharmacological and exercise stress testing: The role of myocardial ischemia and cardiac symptoms

Background  Negative emotions have been linked to ischemic heart disease, but existing research typically involves self-report methods and little is known about non-verbal facial emotion expression. The role of ischemia and anginal symptoms in emotion expression was examined.  Methods  Patients undergoing cardiac stress testing (CST) using bicycle exercise or adenosine with myocardial perfusion imaging were included (N = 256, mean age 66.8 +/- 8.7 year., 43% women). Video images and emotion expression (sadness, anxiety, anger, and happiness) were analyzed at baseline, initial CST , maximal CST, recovery. Nuclear images were evaluated using SPECT.  Results  Ischemia (N = 89; 35%) was associated with higher levels of sadness (p = .017, d = 0.34) and lower happiness (p = .015, d = 0.30). During recovery, patients with both ischemia and anginal symptoms had the highest sadness expression (F (3,254) = 3.67, p = .013, eta(2) = 0.042) and the lowest happiness expression (F (3, 254) = 4.19, p = .006, eta(2) = .048).  Conclusion  Sadness and reduced happiness were more common in patients with ischemia. Also, anginal symptoms were associated with more negative emotions

Facial emotion expression and the inducibility of myocardial ischemia during Cardiac stress testing:The role of psychological background factors

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 [standard deviation] age = 66.9 [8.2] years); 91 (43%) women) using self-report measures and video recordings of facial emotion expression. Video recordings were analyzed for expressed anxiety, anger, sadness, and happiness before CST. Psychological background factors were assessed with validated questionnaires. Single-photon emission computed tomography was used to evaluate inducibility of ischemia. Results Ischemia occurred in 72 patients (34%). Emotional states were not associated with subsequent inducibility of ischemia during CST (odds ratio between 0.93 and 1.04; p values > .50). Psychological background factors were also not associated with ischemia (odds ratio between 0.96 and 1.06 per scale unit; p values > .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

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

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