Psychological Distress and Arrhythmia: Risk Prediction and Potential Modifiers

The connection between the heart and the brain has long been anecdotally recognized but has systematically been studied only relatively recently. Cardiac arrhythmias, especially ventricular arrhythmias that can lead to sudden cardiac death, remain a major public health concern and there is mounting evidence that psychological distress plays a critical role both as a predictor of high-risk cardiac substrate and as an inciting trigger. The transient, unpredictable nature of emotions and cardiac arrhythmias has made their study challenging, but evolving technologies in monitoring and imaging along with larger epidemiological data sets have encouraged more sophisticated studies examining this relationship. Here we review the research on psychological distress including anger, depression and anxiety on cardiac arrhythmias, insights into proposed mechanisms, and potential avenues for future research

Antipsychotic medications and sudden cardiac arrest: More than meets the eye?

Sudden cardiac arrest (SCA) remains an important public health problem and is stubbornly difficult to predict or prevent. A growing literature has emerged studying psychiatric conditions, such as depression and schizophrenia, and risk of arrhythmia and SCA.1–3 This field is challenging from an epidemiologic perspective, partly because of the rarity of SCA events in the general population without known heart disease and the potential confounding factors that may influence findings.4 For instance, there is increased recognition that treatments for mental illness may themselves raise cardiac risk

Perception of Illegal Contrasts: Japanese Adaptations of Korean Coda Obstruents

In lieu of an abstract, here is a brief excerpt:A series of studies by Dupoux and colleagues (Dupoux et al. (1999), Peperkamp & Dupoux (2003), Vendelin & Peperkamp (2004), Peperkamp (2005)) have proposed that loanword adaptation, which refers to the transformation words go through when they are borrowed from a source language (L2) to a borrowing language (L1), happens entirely during perception. They claim that when an L1 speaker is given an acoustic signal that contains segments that are illegal in his native language, his native phonotactics distort how this signal is perceived, automatically mapping it to the closest well-formed sound, and that this process, called perceptual assimilation, often makes it extremely difficult to perceive nonnative sounds accurately. This paper provides evidence partially contrary to their claims, from adaptations of Korean final coda obstruents into Japanese, showing that Japanese speakers are able to perceive some phonotactically illegal contrasts

Reconciling CV phonotactics and high vowel deletion in Japanese

High vowel devoicing is a productive process in Japanese, where /i, u/ become unphonated between voiceless obstruents. Recent studies have shown that the vowels can completely delete as a result of the process, resulting in surface consonant clusters. This seemingly conflicts with the strong CV phonotactic preference that has repeatedly been shown in both phonological and psycholinguistic studies of Japanese. This paper proposes that the apparent conflict can be resolved by having phonotactic repairs and high vowel devoicing apply at different phonological levels, adopting a more sophisticated phonological representation than simple /underlying/ vs. [surface] forms. The proposed framework also makes an empirically testable prediction regarding syllabification of clusters that result from high vowel deletion

Spectral and temporal implementation of Japanese speakers' English vowel categories : a corpus-based study

This study investigates the predictions of second language (L2) speech acquisition models — SLM(-r), PAM(-L2), and L2LP — on how native (L1) Japanese speakers implement the spectral and temporal aspects of L2 American English vowel categories. Data were obtained from 102 L1 Japanese speakers in the J-AESOP corpus, which also includes nativelikeness judgments by trained phoneticians. Spectrally, speakers judged to be non-nativelike showed a strong influence from L1 categories, except L2 /ʌ/ which could be deflected away from L1 /a/ according to SLM(-r) and L2 /ɑː/ which seemed orthographically assimilated to L1 /o/ according to PAM(-L2). More nativelike speakers showed vowel spectra similar to those of native English speakers across all vowels, in accordance with L2LP. Temporally, although speakers tended to equate the phonetic length of English vowels with Japanese phonemic length distinctions, segment-level L1-L2 category similarity was not a significant predictor of the speakers’ nativelikeness. Instead, the implementation of prosodic-level factors such as stress and phrase-final lengthening were better predictors. The results highlight the importance of suprasegmental factors in successful category learning and also reveal a weakness in current models of L2 speech acquisition, which focus primarily on the segmental level. Theoretical and pedagogical implications are discussed

Relationship between premature ventricular complexes and depressive symptoms in non-ST-elevation acute coronary syndrome

Aims: Depression is a recognized risk marker for mortality among acute coronary syndrome (ACS) patients. We hypothesized that ventricular arrhythmia detected by inpatient telemetry monitoring is more frequent among ACS patients with elevated depressive symptoms compared to those without depressive symptoms. Methods and results: We analysed data from patients enrolled in a prospective observational study of depression in ACS. Telemetry recordings during the index admission (average recording 21.3±3.0 hours) were analysed for frequent premature ventricular complexes (PVCs), defined as ≥10 per hour. The self-report Beck Depression Inventory (BDI) was used to assess depressive symptoms. Among 200 ACS patients, frequent PVCs were observed in 29% of patients with moderate depressive symptoms (BDI ≥10), 27% of those with mild symptoms (BDI 5–9), and only 11% of those with no/minimal symptoms (p=0.02). Log-transformed PVCs per hour were associated with depressive symptom category (p=0.008). In a multivariable logistic regression model that included age, gender, left ventricular ejection fraction, cardiovascular risk score, heart rate, and QT interval, mild symptoms (OR 3.02, 95% 0.97–9.43, p=0.058) and moderate-severe symptoms (OR 3.94, 95% CI 1.27–12.22, p=0.018) were associated with frequent PVCs. Conclusions: In this sample of ACS patients, depressive symptoms were independently associated with frequent PVCs during inpatient telemetry monitoring

Correlating perceived arrhythmia symptoms and QoL in the elderly with Heart Failure in an urban clinic: A prospective, single center study

Aims and objectives To determine the relationship between quality of life and perceived self-reported symptoms in an older, ambulatory, urban population living with heart failure. Background While arrhythmias in older individuals with heart failure are well documented, the association between perceived arrhythmia symptoms and quality of life is not well-defined. Design Prospective, cross-sectional single-centre study. Methods A single-centre, prospective study was conducted with heart failure patients recruited from an urban outpatient cardiology clinic in the United States. Fifty-seven patients completed a baseline quality of life survey with 42 of these completing the six-month follow-up survey. Quality of life was evaluated with the SF-36v2™ and frequency of symptoms with the Atrial Fibrillation Severity Scale. Subjects wore an auto triggered cardiac loop monitor (LifeStar AF Express®) for two weeks to document arrhythmias. Data analysis utilised Spearman's rank correlation and logistic regression. Results Baseline and six-month quality of life measures did not correlate with recorded arrhythmias. However, perceptions of diminished general health correlated significantly with symptoms of exercise intolerance, lightheadedness/dizziness, palpitations and chest pain/pressure. By multivariable logistic regression, more severe perceived episodes, symptoms of exercise intolerance and lightheadedness/dizziness were independently associated with diminished quality of life. Conclusion Quality of life was significantly worse in patients with perceptions of severe arrhythmic episodes and in those with symptoms of dizziness and exercise intolerance. Relevance to clinical practice The findings of this study indicate that symptomatic heart failure patients suffer from poor quality of life and that interventions are needed to improve quality of life and decrease symptom severity. Nurses who care for heart failure patients play an essential role in symptom evaluation and management and could significantly improve overall quality of life in these patients by carefully evaluating symptomatology and testing interventions and educational programmes aimed at improving quality of life

A new transform for the analysis of complex fractionated atrial electrograms

Representation of independent biophysical sources using Fourier analysis can be inefficient because the basis is sinusoidal and general. When complex fractionated atrial electrograms (CFAE) are acquired during atrial fibrillation (AF), the electrogram morphology depends on the mix of distinct nonsinusoidal generators. Identification of these generators using efficient methods of representation and comparison would be useful for targeting catheter ablation sites to prevent arrhythmia reinduction. A data-driven basis and transform is described which utilizes the ensemble average of signal segments to identify and distinguish CFAE morphologic components and frequencies. Calculation of the dominant frequency (DF) of actual CFAE, and identification of simulated independent generator frequencies and morphologies embedded in CFAE, is done using a total of 216 recordings from 10 paroxysmal and 10 persistent AF patients. The transform is tested versus Fourier analysis to detect spectral components in the presence of phase noise and interference. Correspondence is shown between ensemble basis vectors of highest power and corresponding synthetic drivers embedded in CFAE. Results: The ensemble basis is orthogonal, and efficient for representation of CFAE components as compared with Fourier analysis (p ≤ 0.002). When three synthetic drivers with additive phase noise and interference were decomposed, the top three peaks in the ensemble power spectrum corresponded to the driver frequencies more closely as compared with top Fourier power spectrum peaks (p ≤ 0.005). The synthesized drivers with phase noise and interference were extractable from their corresponding ensemble basis with a mean error of less than 10%. Conclusions: The new transform is able to efficiently identify CFAE features using DF calculation and by discerning morphologic differences. Unlike the Fourier transform method, it does not distort CFAE signals prior to analysis, and is relatively robust to jitter in periodic events. Thus the ensemble method can provide a useful alternative for quantitative characterization of CFAE during clinical study

Relations Between Depressive Symptoms, Anxiety, and T Wave Abnormalities in Subjects Without Clinically-Apparent Cardiovascular Disease (from the Multi-Ethnic Study of Atherosclerosis [MESA])

The aim of this study was to test the hypothesis that depression and anxiety are associated with electrocardiographic (ECG) repolarization abnormalities in the Multi-Ethnic Study of Atherosclerosis (MESA), a cohort free of symptomatic cardiovascular disease. Depressive symptoms were assessed by using the Center for Epidemiologic Studies Depression Scale and trait anxiety symptoms by using the Spielberger State-Trait Anxiety Inventory; both were categorized according to uppermost quartile. T-wave inversions in ECG leads other than V1 to V3 were obtained from electrocardiograms obtained at rest during the baseline examination. Participants with major intraventricular conduction abnormalities and those taking antiarrhythmics, antidepressants, and/or antipsychotics were excluded. Logistic regression models were estimated with multivariable adjustment for traditional cardiovascular disease risk factors. Among 5,906 participants, elevated depressive symptoms were associated with increased odds of T-wave inversion after multivariable adjustment (odds ratio 2.02, 95% confidence interval 1.33 to 3.06, p = 0.001), whereas greater trait anxiety was associated with reduced odds of T-wave inversion (odds ratio 0.47, 95% confidence interval 0.29 to 0.77, p = 0.003). The divergent associations of depressive symptoms and trait anxiety with ECG T-wave inversions were similar in men and women, and these associations were present across the racial and ethnic subgroups (non-Hispanic white, African-American, Hispanic, and Chinese). In conclusion, symptoms of depression and anxiety were independently yet oppositely associated with ECG T-wave inversions. Negative emotions may have a differential impact on cardiovascular mortality through unique relations with cardiac repolarization

Novel Trial Design: CHIEF-HF

BACKGROUND: The expense of clinical trials mandates new strategies to efficiently generate evidence and test novel therapies. In this context, we designed a decentralized, patient-centered randomized clinical trial leveraging mobile technologies, rather than in-person site visits, to test the efficacy of 12 weeks of canagliflozin for the treatment of heart failure, regardless of ejection fraction or diabetes status, on the reduction of heart failure symptoms. METHODS: One thousand nine hundred patients will be enrolled with a medical record-confirmed diagnosis of heart failure, stratified by reduced (≤40%) or preserved (\u3e40%) ejection fraction and randomized 1:1 to 100 mg daily of canagliflozin or matching placebo. The primary outcome will be the 12-week change in the total symptom score of the Kansas City Cardiomyopathy Questionnaire. Secondary outcomes will be daily step count and other scales of the Kansas City Cardiomyopathy Questionnaire. RESULTS: The trial is currently enrolling, even in the era of the coronavirus disease 2019 (COVID-19) pandemic. CONCLUSIONS: CHIEF-HF (Canagliflozin: Impact on Health Status, Quality of Life and Functional Status in Heart Failure) is deploying a novel model of conducting a decentralized, patient-centered, randomized clinical trial for a new indication for canagliflozin to improve the symptoms of patients with heart failure. It can model a new method for more cost-effectively testing the efficacy of treatments using mobile technologies with patient-reported outcomes as the primary clinical end point of the trial