Summary: Experiencing anger and ongoing stress is linked to poorer baseline diastolic pressure and impaired diastolic function. The findings point to a connection between psychological stress, anger, and increased risk for cardiac events in patients with heart failure.
Source: Yale
Mental stress and episodes of anger can have measurable clinical effects for patients living with heart failure, according to a new report published in the Journal of Cardiac Failure.
Heart failure is a serious cardiovascular condition in which heart muscle is damaged or weakened and cannot pump blood as effectively. In many patients this manifests as reduced left ventricular ejection fraction (LVEF), meaning the heart ejects a lower-than-normal proportion of blood with each contraction. Beyond systolic impairment, diastolic function — the heart’s ability to relax and refill between beats — is a critical determinant of symptoms and long-term prognosis.
In this study of patients with heart failure with reduced ejection fraction (HFrEF), researchers including investigators at Yale examined how everyday experiences of stress and anger and controlled laboratory mental stressors affect indices of diastolic function. The investigators used daily self-reports to capture short-term emotional states and applied standardized mental stress tasks while measuring diastolic performance with echocardiography.
Participants completed daily questionnaires for seven consecutive days, reporting perceived stress, episodes of anger, and other negative emotions experienced during the prior 24 hours. After this ambulatory assessment, each participant underwent a laboratory mental stress protocol consisting of a challenging mental arithmetic task and an anger-recall task in which they described a recent distressing or anger-provoking event. Two-dimensional Doppler echocardiography was used to measure key diastolic indices — including transmitral inflow (E), tissue Doppler early relaxation velocity (e’), and the ratio E/e’ that estimates left ventricular filling pressure — both at rest and during the stress tasks.
The study found that patients who reported greater anger during the week before testing had worse resting diastolic pressure as reflected by higher baseline E/e’. During the laboratory stress protocol, most participants showed stress-provoked changes in diastolic function. Specifically, many patients experienced decreased early LV relaxation (lower e’) and increased diastolic filling pressures (higher E/e’) when exposed to mental stress.
“Mental stress is common in patients with heart failure, in part because self-management is complex, physical abilities often decline over time, and repeated symptom flares and hospitalizations create ongoing strain,” said Kristie Harris, the study’s lead author and a postdoctoral associate in cardiovascular medicine at Yale. The authors emphasize that these emotional and physiological responses may help explain why some patients with heart failure experience a more burdensome disease course.
The investigators note that repeated exposures to mental stress or ongoing anger could carry clinical consequences for patients who are vulnerable to stress-related changes in cardiac function. “We have evidence that chronically elevated stress is associated with poorer quality of life and greater risk for adverse events among people with heart disease,” Harris said. She also highlighted the potential for pandemic-related stressors to compound typical burdens experienced by patients with heart failure.
Matthew Burg, a Yale clinical psychologist and senior author, added that stress and anger are often under-recognized and under-treated in cardiology care. Prior work has shown that stress management strategies can lower risk among patients with ischemic heart disease; this study extends concern about stress-related cardiac effects to chronic heart failure. Burg and colleagues call for additional research to identify which patients are most vulnerable to stress and anger and to determine whether targeted interventions could improve outcomes in HFrEF.
About this research
Source:
Yale University news release
Contacts:
Elisabeth Reitman – Yale
Image Source:
Public domain image
Original Research:
“Impact of Mental Stress and Anger on Indices of Diastolic Function in Patients with Heart Failure” by Kristie M. Harris, John S. Gottdiener, Stephen S. Gottlieb, Matthew M. Burg, Shuying Li, David S. Krantz. Journal of Cardiac Failure. (Closed access)
Abstract
Impact of Mental Stress and Anger on Indices of Diastolic Function in Patients with Heart Failure
Background
While controlled mental stress is known to produce reductions in ventricular performance in some settings, the specific effects of mental stress on diastolic function in patients with heart failure have been less well characterized.
Methods and Results
The study enrolled twenty-four patients with ischemic cardiomyopathy and reduced ejection fraction (HFrEF), the majority of whom were men. Participants completed daily assessments of perceived stress, anger, and negative emotion for seven days and then underwent a laboratory mental stress protocol including anger recall and mental arithmetic. Echocardiographic measures of diastolic function (E, e’, and E/e’) were recorded at rest and during stress. Fourteen patients (approximately 64%) experienced an increase in E/e’ during stress, with an average change indicating worsened diastolic pressure primarily driven by a decrease in early LV relaxation (e’). Age-adjusted analyses showed an association between higher 7-day anger scores and elevated baseline E/e’, indicating worse resting diastolic pressure among those reporting more anger prior to testing.
Conclusions
In patients with HFrEF, acute mental stress can provoke worsening of left ventricular diastolic pressure, and recent experiences of anger are associated with worse resting diastolic pressure. For patients susceptible to these stress-related changes, repeated or chronic exposures to stress and anger may have implications for symptoms and long-term outcomes. These findings underscore the importance of recognizing and addressing emotional stressors as part of comprehensive heart failure care, and they point to the need for additional research on stress vulnerability and stress-reduction interventions in this population.