Department of Biomedical Informatics, Emory University, Georgia, Atlanta, USA.
School of Electrical and Computer Engineering, Georgia Institute of Technology, Georgia, Atlanta, USA.
Psychophysiology. 2023 Mar;60(3):e14197. doi: 10.1111/psyp.14197. Epub 2022 Oct 26.
Post-traumatic stress disorder (PTSD) is an independent risk factor for incident heart failure, but the underlying cardiac mechanisms remained elusive. Impedance cardiography (ICG), especially when measured during stress, can help understand the underlying psychophysiological pathways linking PTSD with heart failure. We investigated the association between PTSD and ICG-based contractility metrics (pre-ejection period (PEP) and Heather index (HI)) using a controlled twin study design with a laboratory-based traumatic reminder stressor. PTSD status was assessed using structured clinical interviews. We acquired synchronized electrocardiograms and ICG data while playing personalized-trauma scripts. Using linear mixed-effects models, we examined twins as individuals and within PTSD-discordant pairs. We studied 137 male veterans (48 pairs, 41 unpaired singles) from Vietnam War Era with a mean (standard deviation) age of 68.5(2.5) years. HI during trauma stress was lower in the PTSD vs. non-PTSD individuals (7.2 vs. 9.3 [ohm/s ], p = .003). PEP reactivity (trauma minus neutral) was also more negative in PTSD vs. non-PTSD individuals (-7.4 vs. -2.0 [ms], p = .009). The HI and PEP associations with PTSD persisted for adjusted models during trauma and reactivity, respectively. For within-pair analysis of eight PTSD-discordant twin pairs (out of 48 pairs), PTSD was associated with lower HI in neutral, trauma, and reactivity, whereas no association was found between PTSD and PEP. PTSD was associated with reduced HI and PEP, especially with trauma recall stress. This combination of increased sympathetic activation and decreased cardiac contractility combined may be concerning for increased heart failure risk after recurrent trauma re-experiencing in PTSD.
创伤后应激障碍（PTSD）是心力衰竭的独立危险因素，但潜在的心脏机制仍不清楚。阻抗心动图（ICG），特别是在应激时测量时，可以帮助了解将 PTSD 与心力衰竭联系起来的潜在心理生理途径。我们使用基于实验室的创伤性提醒应激源的对照双胞胎研究设计，研究了 PTSD 与基于 ICG 的收缩力指标（射血前期（PEP）和希瑟指数（HI））之间的关联。使用结构化临床访谈评估 PTSD 状态。当播放个性化创伤脚本时，我们获取同步心电图和 ICG 数据。使用线性混合效应模型，我们将双胞胎作为个体并在 PTSD 不一致的双胞胎对中进行了研究。我们研究了 137 名来自越南战争时期的男性退伍军人（48 对，41 个非配对个体），平均（标准差）年龄为 68.5（2.5）岁。创伤应激时 HI 在 PTSD 与非 PTSD 个体中较低（7.2 与 9.3 [ohm/s]，p = 0.003）。与非 PTSD 个体相比，PTSD 个体的 PEP 反应性（创伤与中性）也更为负性（-7.4 与 -2.0 [ms]，p = 0.009）。在调整后的创伤和反应性模型中，HI 和 PEP 与 PTSD 的关联仍然存在。对于 48 对双胞胎中的 8 对 PTSD 不一致的双胞胎进行的双胞胎内分析，中性、创伤和反应时的 PTSD 与 HI 降低有关，而 PTSD 与 PEP 之间无关联。PTSD 与 HI 和 PEP 降低有关，尤其是与创伤回忆应激有关。在 PTSD 中反复经历创伤后，这种交感神经激活增加和心脏收缩力降低的组合可能与心力衰竭风险增加有关。
