Left Ventricular Ejection Fraction Predicts Severity of Posttraumatic Stress Disorder in Patients With Implantable Cardioverter‐Defibrillators

Abstract

Background: Implantable cardioverter-defibrillators (ICD) have provided effective therapy for fatal arrhythmia. However, ICD patients are known to develop psychological problems, such as posttraumatic stress disorder (PTSD), if they have experienced potentially fatal arrhythmia and ICD shocks. Little is known about the factors influencing PTSD in ICD patients. Hypothesis: Echocardiographic cardiac-function parameters might relate to psychological problems, especially PTSD, in ICD patients. Methods: A total of 128 outpatients with ICD implantation completed the Impact of Event Scale Revised (IES-R) questionnaire as a measurement of PTSD. Demographic and clinical characteristic data were collected from medical records. Results: The mean age of the ICD patients was 59 ± 16 years; 103 were male; and the mean left ventricular ejection fraction (LVEF) by echocardiography was 52.4% ± 18.3%. In the ICD patients, female sex and impaired LVEF were related to lower IES-R scores or led to PTSD (P = 0.01 and P = 0.03, respectively). Impaired LVEF also worsened 2 symptoms of PTSD, intrusion (P = 0.02) and hyperarousal (P = 0.03). In patients with LVEF <35%, there was a significant negative correlation between LVEF level and IES-R score (P = 0.045).Conclusions: This study showed that LVEF was related to the severity of PTSD, especially in the ICD patients with LVEF of <35%. We should pay more attention to ICD patients with severely impaired left ventricular function to prevent psychological problems.

Evaluation of depression, anxiety, and stress symptoms and their relationship with subclinical myocardial dysfunction by left ventricular global longitudinal strain in patients who recovered from COVID-19

“…51 Moreover, Sawatari et al found similar negative correlation value to our results between LVEF levels and IES-R scores in patients with implantable cardioverter-defibrillators (r = -0.36, p = 0.045). 52 Although we observed lower correlations in total patient population, we found higher significantly correlation coefficients between LVGLS values and IES-R total, and intrusion scores in patients admitted with severe pneumonia and also having comorbidity. Therefore, we may speculate that patients with comorbid diseases, or recovering from the severe illness with challenging treatment history of COVID-19 may have experienced more psychological stress reactions which may have had a more negative impact on subclinical myocardial systolic functions.…”

“…51 Moreover, Sawatari et al found similar negative correlation value to our results between LVEF levels and IES-R scores in patients with implantable cardioverter-defibrillators (r = -0.36, p = 0.045). 52 …”

Post-traumatic Stress Disorder and Risk Factors in Patients With Acute Myocardial Infarction After Emergency Percutaneous Coronary Intervention: A Longitudinal Study

“… Newman et al (2011) surveyed 241 patients with acute coronary syndromes and reported that those with PTSD symptoms (18%) were higher than those without PTSD symptoms (82%) (LVEF: 53.0 vs. 46.1%). In addition, ( Sawatari et al, 2016 ) found that LVEF level was a useful to predict of PTSD severity. Therefore, early active treatment should be carried out to improve the cardiac function of severe AMI patients to promote the early recovery, reduce psychological stress, and prevent, or reduce PTSD, or both.…”

Reduced left ventricular diastolic function in women with posttraumatic stress disorder

“…To date, very few published studies have examined cardiac function in PTSD patients (2,6,8). Sawatari et al (27) found that left ventricular ejection fraction (LVEF), an indication of systolic function, was related to the severity of PTSD. It remains unknown whether LV diastolic function is impaired in patients with PTSD.…”