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Early-life trauma tied to ECG changes indicating risk of arrhythmia during mental stress

Journal of the American Heart Association
Reuters Health - 25/02/2022 - Early-life trauma was associated with a higher risk of elevated microvolt T-wave alternanas (TWA), a marker of increased arrhythmia risk, during mental stress in individuals with stable coronary artery disease, new research shows.

"We were surprised by the strength of association despite adjustment for other psychological conditions such as post-traumatic stress disorder and cardiac risk factors," Dr. Amit Shah of Emory University in Atlanta told Reuters Health by email.

"Although queries about early life stress are not common practice, we are gaining a better understanding of where this may play a role," he said. His team recently published a statement paper on the topic in Psychosomatic Medicine (https://bit.ly/3BQyVXw).

For the current study, as reported in the Journal of the American Heart Association, Dr. Shah and colleagues examined early life trauma with the Early Trauma Inventory Self Report-Short Form in a substudy of the Mental Stress Ischemia: Prognosis and Genetic Influences study (https://bit.ly/3LZiMno).

They started collecting ambulatory ECG data approximately two years after the parent investigation began.

The 320 participants (mean age, 64; 27%, women; 27%) underwent a mental stress speech task with Holter monitoring, as well as a structured psychiatric interview. TWA was measured during rest, mental stress, and recovery with ambulatory electrocardiographic (ECG) monitoring.

Twenty-seven percent of participants reported significant childhood trauma, with a score of 10 or more on the Early Trauma Inventory Self Report-Short Form (ETI-SF).

After adjustment for sociodemographic factors, cardiac history, psychiatric comorbidity, and hemodynamic stress reactivity, high childhood trauma was associated with a 17% increase in TWA during stress; each unit increase in the ETI-SF was associated with a 1.7% higher stress TWA, with the largest effect sizes seen in the emotional trauma subtype.

Further, the mean value of TWA increased from 11.6 microV at baseline to 17.1 microV during the mental stress phase and decreased to 15.9 microV during recovery, indicating repolarization heterogeneity during acute trauma. Each increased point of the total and emotional trauma score was associated with a 1.6% and 5.4% increased TWA, respectively.

"Early trauma exposures may affect long-term sudden cardiac death risk during emotional triggers, although more studies are warranted," the authors conclude.

Dr. Shah said, "The study generally supports the importance of asking about stress in certain medical settings. Clinical encounters where arrhythmias are involved may in particular benefit from a stress evaluation and referral for treatment. More public health efforts are needed to address and prevent domestic violence, and this study underscores the need for such."

Dr. Shah added that his team is currently looking at these relationships in a large cohort of Veterans and focusing on the relationship of daily stressors in the home setting with arrhythmia risk.

SOURCE: https://bit.ly/3ImVzsZ Journal of the American Heart Association, online February 15, 2022.

By Marilynn Larkin 

© 2023 The Author(s). Published by Medicom Medical Publishers.
User license: Creative Commons Attribution – NonCommercial (CC BY-NC 4.0)

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