von Känel Roland, Meister-Langraf Rebecca E, Zuccarella-Hackl Claudia, Znoj Hansjörg, Pazhenkottil Aju P, Schmid Jean-Paul, Barth Jürgen, Schnyder Ulrich, Princip Mary
Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Clienia Schlössli AG, Zurich, Switzerland.
Front Cardiovasc Med. 2022 Apr 14;9:852710. doi: 10.3389/fcvm.2022.852710. eCollection 2022.
After acute coronary syndrome (ACS), one in eight patients develops clinically significant symptoms of Post-traumatic stress disorder (PTSD). We hypothesized that changes in cardiac symptoms from 3 to 12 months after ACS are associated with changes in ACS-induced PTSD symptoms.
At 3 ( = 154) and/or 12 months ( = 106) post-ACS, patients ( = 156, mean age 59 years, 85% men) completed a clinical interview assessing chest tightness/pain (at rest and/or during exertion), heartbeat symptoms (heart palpitations, racing of heart, heart stumbling or skipping a beat) and PTSD symptoms during the prior 4 weeks. Random mixed regression models examined the association between the onset (or remission) from 3 to 12 months in cardiac symptoms with changes in PTSD symptoms, adjusting for a range of potential predictors of ACS-induced PTSD symptoms.
The onset of chest tightness/pain [estimate = 0.588, 95% confidence interval: 0.275, 0.090; < 0.001] and of heartbeat symptoms [0.548 (0.165, 0.931); = 0.005] from 3 to 12 months was independently associated with an increase in total PTSD symptoms. There were also independent associations between the onset of chest tightness/pain and heartbeat symptoms with an increase in PTSD symptom clusters. Specifically, the onset of chest tightness/pain showed associations with an increase in re-experiencing [0.450 (0.167, 0.733); = 0.027] and avoidance/numbing [0.287 (0.001, 0.574); = 0.049]. The onset of heartbeat symptoms showed associations with an increase in re-experiencing [0.392 (0.045, 0.739); = 0.002], avoidance/numbing [0.513 (0.161, 0.864); = 0.004] and hyperarousal [0.355 (0.051, 0.659); = 0.022]. An increase in the total number of cardiac symptoms (score range 0-6) was also associated with an increase in total PTSD symptoms [0.343 (0.202, 0.484); < 0.001]. Psychotherapy in the post-hospital period moderated the association between the change in heartbeat symptoms and the change in total PTSD symptoms [-0.813 (-1.553, -0.074); = 0.031 for interaction]; the association between the onset of heart beat symptoms and an increase in total PTSD symptoms was weaker in patients who attended psychotherapy [0.437 (-0.178, 1.052); = 0.16] than in those who did not [0.825 (0.341, 1.309); < 0.001].
Changes in cardiac symptoms between 3 and 12 months after hospitalization are associated with changes in ACS-induced PTSD symptoms. ClinicalTrials.gov #NCT01781247.
急性冠状动脉综合征（ACS）后，八分之一的患者会出现具有临床意义的创伤后应激障碍（PTSD）症状。我们假设，ACS后3至12个月心脏症状的变化与ACS诱发的PTSD症状的变化相关。
在ACS后3个月（n = 154）和/或12个月（n = 106）时，患者（n = 156，平均年龄59岁，85%为男性）完成了一项临床访谈，评估前4周内的胸闷/胸痛（静息和/或运动时）、心跳症状（心悸、心跳加速、心跳紊乱或漏跳）以及PTSD症状。随机混合回归模型检验了3至12个月内心脏症状的发作（或缓解）与PTSD症状变化之间的关联，并对一系列ACS诱发的PTSD症状的潜在预测因素进行了调整。
3至12个月内胸闷/胸痛的发作[估计值 = 0.588，95%置信区间：0.275，0.090；P < 0.001]和心跳症状的发作[0.548（0.165，0.931）；P = 0.005]与PTSD总症状的增加独立相关。胸闷/胸痛和心跳症状的发作与PTSD症状簇的增加之间也存在独立关联。具体而言，胸闷/胸痛的发作与重新体验症状的增加相关[0.450（0.167，0.733）；P = 0.027]以及回避/麻木症状的增加相关[0.287（0.001，0.574）；P = 0.049]。心跳症状的发作与重新体验症状的增加相关[0.392（0.045，0.739）；P = 0.002]、回避/麻木症状的增加相关[0.513（0.161，0.864）；P = 0.004]以及过度警觉症状的增加相关[0.355（0.051，0.659）；P = 0.022]。心脏症状总数的增加（评分范围0 - 6）也与PTSD总症状的增加相关[0.343（0.202，0.484）；P < 0.001]。出院后接受心理治疗可调节心跳症状变化与PTSD总症状变化之间的关联[-0.813（-1.553，-0.074）；交互作用P = 0.031]；接受心理治疗的患者中，心跳症状发作与PTSD总症状增加之间的关联[0.437（-0.178，1.052）；P = 0.16]比未接受心理治疗的患者[0.825（0.341，1.309）；P < 0.001]更弱。
住院后3至12个月内心脏症状的变化与ACS诱发的PTSD症状的变化相关。ClinicalTrials.gov #NCT01781247。
