Vaccarino Viola, Shah Amit J, Moncayo Valeria, Nye Jonathon, Piccinelli Marina, Ko Yi-An, Ma Xin, Murrah Nancy, Shallenberger Lucy, Driggers Emily, Levantsevych Oleksiy M, Hammadah Muhammad, Lima Bruno B, Young An, O'Neal Wesley, Alkhalaf Mhmtjamil, Haffar Ammer, Raggi Paolo, Goldberg Jack, Smith Nicholas L, Garcia Ernest V, Quyyumi Arshed A, Bremner J Douglas
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; Atlanta Veterans Affairs Health Care System, Decatur, Georgia.
Biol Psychiatry. 2022 Apr 1;91(7):615-625. doi: 10.1016/j.biopsych.2021.09.016. Epub 2021 Sep 27.
The link between posttraumatic stress disorder (PTSD) and ischemic heart disease remains elusive owing to a shortage of longitudinal studies with a clinical diagnosis of PTSD and objective measures of cardiac compromise.
We performed positron emission tomography in 275 twins who participated in two examinations approximately 12 years apart. At both visits, we obtained a clinical diagnosis of PTSD, which was classified as long-standing (both visit 1 and visit 2), late onset (only visit 2), and no PTSD (no PTSD at both visits). With positron emission tomography, we assessed myocardial flow reserve (MFR), which, in absence of significant coronary stenoses, indexes coronary microvascular function. We compared positron emission tomography data at visit 2 across the three categories of longitudinally assessed PTSD and examined changes between the two visits.
Overall, 80% of the twins had no or minimal obstructive coronary disease. Yet, MFR was depressed in twins with PTSD and was progressively lower across groups with no PTSD (2.13), late-onset PTSD (1.97), and long-standing PTSD (1.93) (p = .01). A low MFR (a ratio <2.0) was present in 40% of the twins without PTSD, in 56% of those with late-onset PTSD, and in 72% of those with long-standing PTSD (p < .001). Associations persisted in multivariable analysis, when examining changes in MFR between visit 1 and visit 2, and within twin pairs. Results were similar by zygosity.
Longitudinally, PTSD is associated with reduced coronary microcirculatory function and greater deterioration over time. The association is especially noted among twins with chronic, long-standing PTSD and is not confounded by shared environmental or genetic factors.
由于缺乏对创伤后应激障碍（PTSD）进行临床诊断并采用心脏损害客观指标的纵向研究，PTSD与缺血性心脏病之间的联系仍不明确。
我们对275对双胞胎进行了正电子发射断层扫描，这些双胞胎大约相隔12年参加了两次检查。在两次检查时，我们均获得了PTSD的临床诊断，其被分类为长期存在（检查1和检查2时均存在）、迟发性（仅检查2时存在）和无PTSD（两次检查时均无PTSD）。通过正电子发射断层扫描，我们评估了心肌血流储备（MFR），在无明显冠状动脉狭窄的情况下，MFR可反映冠状动脉微血管功能。我们比较了纵向评估的PTSD三类情况在检查2时的正电子发射断层扫描数据，并检查了两次检查之间的变化。
总体而言，80%的双胞胎没有或仅有轻微的阻塞性冠状动脉疾病。然而，PTSD双胞胎的MFR降低，且在无PTSD（2.13）、迟发性PTSD（1.97）和长期存在PTSD（1.93）的组中逐渐降低（p = 0.01）。无PTSD的双胞胎中有40%、迟发性PTSD的双胞胎中有56%以及长期存在PTSD的双胞胎中有72%存在低MFR（比率<2.0）（p < 0.001）。在多变量分析中，当检查检查1和检查2之间以及双胞胎对内部MFR的变化时，相关性仍然存在。按合子性分析结果相似。
纵向来看，PTSD与冠状动脉微循环功能降低以及随时间推移的更大程度恶化相关。这种关联在患有慢性、长期存在PTSD的双胞胎中尤为明显，且不受共同环境或遗传因素的混淆。
