Early Life Trauma Is Associated With Increased Microvolt T‐Wave Alternans During Mental Stress Challenge: A Substudy of Mental Stress Ischemia: Prognosis and Genetic Influences

Author:

Shah Amit J.123ORCID,Weeks Virginia4,Lampert Rachel5ORCID,Bremner J. Douglas67ORCID,Kutner Michael8ORCID,Raggi Paolo9ORCID,Sun Yan V.1ORCID,Lewis Tené T.1ORCID,Levantsevych Oleksiy1ORCID,Kim Ye Ji1ORCID,Hammadah Muhammad12,Alkhoder Ayman2,Wittbrodt Matthew6,Pearce Brad D.1,Ward Laura8,Sheps David10,Quyyumi Arshed A.2ORCID,Vaccarino Viola12ORCID

Affiliation:

1. Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA

2. Division of Cardiology Department of Medicine Emory University Atlanta GA

3. Atlanta Veterans Affairs Healthcare System Decatur GA

4. School of Medicine Emory University Atlanta GA

5. Division of Cardiology Department of Medicine Yale University School of Medicine New Haven CT

6. Department of Psychiatry and Behavioral Sciences School of Medicine Emory University Atlanta GA

7. Department of Psychiatry and Department of Radiology Emory University, School of MedicineEmory University Atlanta GA

8. Department of Biostatistics Rollins School of Public Health Emory University Atlanta GA

9. Department of Medicine Mazankowski Alberta Heart InstituteUniversity of Alberta Edmonton Alberta Canada

10. Department of Epidemiology University of Florida Gainesville FL

Abstract

Background Early life trauma has been associated with increased cardiovascular risk, but the arrhythmic implications are unclear. We hypothesized that in patients with coronary artery disease, early life trauma predicts increased arrhythmic risk during mental stress, measured by elevated microvolt T‐wave alternans (TWA), a measure of repolarization heterogeneity and sudden cardiac death risk. Methods and Results In a cohort with stable coronary artery disease (NCT04123197), we examined early life trauma with the Early Trauma Inventory Self Report‐Short Form. Participants underwent a laboratory‐based mental stress speech task with Holter monitoring, as well as a structured psychiatric interview. We measured TWA during rest, mental stress, and recovery with ambulatory electrocardiographic monitoring. We adjusted for sociodemographic factors, cardiac history, psychiatric comorbidity, and hemodynamic stress reactivity with multivariable linear regression models. We examined 320 participants with noise‐ and arrhythmia‐free ECGs. The mean (SD) age was 63.8 (8.7) years, 27% were women, and 27% reported significant childhood trauma (Early Trauma Inventory Self Report‐Short Form ≥10). High childhood trauma was associated with a multivariable‐adjusted 17% increase in TWA ( P =0.04) during stress, and each unit increase in the Early Trauma Inventory Self Report‐Short Form total score was associated with a 1.7% higher stress TWA ( P =0.02). The largest effect sizes were found with the emotional trauma subtype. Conclusions In a cohort with stable coronary artery disease, early life trauma, and in particular emotional trauma, is associated with increased TWA, a marker of increased arrhythmic risk, during mental stress. This association suggests that early trauma exposures may affect long‐term sudden cardiac death risk during emotional triggers, although more studies are warranted.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine

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