Anxiety and depression relationship with coronary slow flow

Current Status and Factors Influencing Mental Health Literacy in Patients With Coronary Heart Disease: A Cross-Sectional Study

This study aimed to investigate the current status of mental health literacy and related influencing factors in patients with coronary heart disease. Four hundred and thirty-five patients with coronary heart disease were recruited in this survey. Data collection was conducted using the General Information Questionnaire, the Chinese version of the Mental Health Literacy Scale, Coronary Artery Disease Self-Management Scale, Social Support Rating Scale, and Coronary Heart Disease Self-Efficacy Scale. Descriptive methods, independent samples t-test or one-way ANOVA, Pearson's correlation analysis, and multiple linear regression were used for data analysis. The results showed that the mean total mental health literacy score of patients with coronary heart disease was 96.42 ± 8.40; gender, age, education level, monthly per capita family income, first diagnosed with coronary heart disease, cardiac function classification, self-management ability, social support, and self-efficacy were the factors influencing the level of mental health literacy in patients with coronary heart disease (all p < 0.05). The study suggests that mental health literacy can improve patients' self-management ability and self-efficacy, and healthcare professionals should emphasize the strengthening of this aspect of health education in order to better improve patient's prognosis.

Comparative study of myocardial perfusion and coronary flow velocity reserve derived from adenosine triphosphate stress myocardial contrast echocardiography in coronary lesions with no/mild stenosis

Background

Qualitative myocardial perfusion (QMP) derived from myocardial contrast echocardiography reflects the capillary flow, while coronary flow velocity reserve from Doppler spectrum (D-CFVR) of the left anterior descending coronary artery (LAD) is used to assess coronary microvascular function, particularly after excluding severe epicardial coronary stenosis. The present study aimed to assess the relationship of QMP and D-CFVR in detecting coronary microvascular disease (CMVD) by using adenosine triphosphate stress myocardial contrast echocardiography (ATP stress MCE).

Methods and results

Seventy-two patients (mean age: 54.22 ± 12.78 years) with chest pain and <50% coronary stenosis diagnosed by quantitative coronary angiography or dual-source CT underwent ATP stress MCE. The distribution of myocardial perfusion and CFVR value was estimated by experienced physicians. Of the 72 LAD with 0%-50% diameter stenosis, 15 (21%) exhibited abnormal CFVR and 31 (43%) displayed abnormal perfusion with ATP stress MCE. Eleven of the 15 LAD territories (73%) with abnormal CFVR values showed abnormal perfusion. However, CFVR was considered normal in 20 LAD territories (35%), despite the presence of perfusion defect in the territory.

Conclusion

Abnormal myocardial perfusion during ATP stress MCE was found in a sizable percentage of patients in whom CFVR of the supplying vessel was considered normal.

Effect of nano-curcumin supplementation on cardiometabolic risk factors, physical and psychological quality of life, and depression in patients with coronary slow flow phenomenon: a randomized double-blind clinical trial

BACKGROUND

Extensive evidence has suggested the cardio-protective properties of the polyphenol curcumin. The aim of this study was to investigate the effects of a highly bioavailable curcumin supplement on cardiometabolic risk factors, health-related quality of life, and depression in patients with coronary slow flow phenomenon (CSFP).

METHODS

This randomized double-blind placebo-controlled clinical trial was conducted in 42 patients with CSFP (age 35-70 years, 25 ≤ body mass index < 40 kg/m2). Patients received either 80 mg/day nano-curcumin or placebo for 12 weeks. Serum levels of visfatin, high-sensitivity C-reactive protein (hs-CRP), and glycemic indices were measured before and after the intervention. The short form 36-item quality of life (SF-36) and Beck's Depression Inventory-II (BDI-II) questionnaires were assessed, as well.

RESULTS

No significant improvements were observed in circulating hs-CRP and visfatin following the intervention. A significant increase was observed in pre- to post-fasting blood glucose (- 0.9 ± 12.2 vs. 7.7 ± 12.4 mg/dl, p = 0.02) and hemoglobin A1C (- 0.1 ± 0.8 vs. 0.5 ± 0.8%, p = 0.04) levels, in the placebo compared with the intervention group. Physical (8.2 ± 8.1 vs. - 1.2 ± 6.5, p < 0.001) and mental (6.8 ± 11.8 vs. - 1.1 ± 10.4, p = 0.02) component summary scores were significantly improved in the nano-curcumin than the placebo group. Additionally, the number of patients with lower degrees of depression was significantly better in the intervention than the placebo group following the supplementation (p = 0.046).

CONCLUSION

Curcumin supplementation prevented deterioration of glycemic control and improved physical and psychological quality of life and depression in patients with CSFP.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials (IRCT20131125015536N8), June 19, 2019.

Significance of depression and androgen deficiency in development of myocardial infarction in young males

In the recent years, close attention has been paid to the study of depression in general medical practice, in particular, among patients with myocardial infarction (MI). Two large groups of factors, which presumably cause such a relationship, are discussed. The first group includes direct pathophysiological factors, the second – indirect, "behavioral" reactions modifying other risk factors for coronary artery disease and reduce patient adherence to prescribed therapy. The age of patients in the observed populations, as well as the predominant type of MI in patients, may have a certain influence on the results of studies. Besides, today, no unambiguous view has been formed on the question of the relationship between the androgenic status of men and the development of coronary artery disease. Among the articles analyzing the effect of androgen levels on the course of coronary heart disease, most of the studies are devoted to androgen content in the blood serum among men with stable angina, while there are relatively few studies evaluating androgen status in acute myocardial infarction and postinfarction cardiosclerosis. On the one hand, it is assumed that age-related androgen deficiency in middle-aged men with coronary heart disease may be a compensatory response to a severe general disease and can contribute to better long-term results of myocardial revascularization in them. On the other hand, it was found that men with coronary heart disease and age-related hypogonadism are characterized by more pronounced manifestations of myocardial ischemia, dysfunction of the autonomic nervous system, and more severe atherosclerosis of the coronary arteries. A review of the latest evidence is presented, summarizing clinical data on the impact of depression and androgen deficiency in the development of myocardial infarction in young men.

Major Adverse Cardiovascular Events and Prognosis in Patients With Coronary Slow Flow

This study aimed to investigate its clinical implications, risk factors, prognosis, and overall long-term outcomes. Demographic profiles, various clinical characteristics, and clinical outcomes were compared between 614 patients with coronary slow flow (CSF) and 428 patients with normal coronary artery. The incidence of CSF was found to be 2.65%. Significant differences were observed between patients with CSF and control subjects in terms of sex, chest tightness, hyperlipidemia, smoking history, alcohol consumption, age, height, weight, body mass index, diastolic blood pressure, heart rate, and body surface area (P < 0.05). CSF (hazard ratio: 1.531; 95% confidence interval: 1.064-2.202; p = 0.022) proved to be independent prognostic predictors of major adverse cardiovascular events (MACEs). Kaplan-Meier survival evaluations for MACEs presented a worser outcome for patients with CSF. Patients with CSF are at high risk for cardiovascular events and experience generally poor clinical outcomes.

Relationship between quantitative epicardial adipose tissue based on coronary computed tomography angiography and coronary slow flow

BACKGROUND

The purpose of this study was to explore the relationship between quantitative epicardial adipose tissue (EAT) based on coronary computed tomography angiography (CCTA) and coronary slow flow (CSF).

METHODS

A total of 85 patients with < 40% coronary stenosis on diagnostic coronary angiography were included in this retrospective study between January 2020 and December 2021. A semi-automatic method was developed for EAT quantification on CCTA images. According to the thrombolysis in myocardial infarction flow grade, the patients were divided into CSF group (n = 39) and normal coronary flow group (n = 46). Multivariate logistic regression was used to explore the relationship between EAT and CSF. Receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic value of EAT in CSF.

RESULTS

EAT volume in the CSF group was significantly higher than that of the normal coronary flow group (128.83± 21.59 mL vs. 101.87± 18.56 mL, P < 0.001). There was no significant difference in epicardial fat attenuation index between the two groups (P > 0.05). Multivariate logistic regression analysis showed that EAT volume was independently related to CSF [odds ratio (OR) = 4.82, 95% confidence interval (CI): 3.06-7.27, P < 0.001]. The area under ROC curve for EAT volume in identifying CSF was 0.86 (95% CI: 0.77-0.95). The optimal cutoff value of 118.46 mL yielded a sensitivity of 0.80 and a specificity of 0.94.

CONCLUSIONS

Increased EAT volume based on CCTA is strongly associated with CSF. This preliminary finding paves the way for future and larger studies aimed to definitively recognize the diagnostic value of EAT in CSF.

Using Mendelian randomization analysis to determine the causal connection between unpleasant emotions and coronary atherosclerosis

Objective

Observational studies have shown a correlation between unpleasant emotions and coronary atherosclerosis, but the underlying causal linkages are still uncertain. We conducted a Mendelian randomization (MR) investigation on two samples for this purpose.

Methods

In genome-wide association studies in the UK Biobank (total = 459,561), we selected 40 distinct single-nucleotide polymorphisms (SNPs) related to unpleasant emotions as genome-wide statistically significant instrumental variables. FinnGen consortium provided summary-level data on coronary atherosclerosis for 211,203 individuals of Finnish descent. MR-Egger regression, the inverse variance weighted technique (IVW), and the weighted median method were used in the process of conducting data analysis.

Results

There was sufficient evidence to establish a causal connection between unpleasant emotions and coronary atherosclerosis risk. For each unit increase in the log-odds ratio of unpleasant feelings, the odds ratios were 3.61 (95% CI: 1.64-7.95; P = 0.001). The outcomes of sensitivity analyses were comparable. There was no indication of heterogeneity or directional pleiotropy.

Conclusion

Our findings provide causal evidence for the effects of unpleasant emotions on coronary atherosclerosis.

Spirituality as a protective factor for chronic and acute anxiety in Brazilian healthcare workers during the COVID-19 outbreak

Background

Anxiety symptoms (AS) are exacerbated in healthcare workers (HCWs) during the COVID-19 pandemic. Spirituality is known to protect against AS in the general population and it is a construct that differs from religion. It can be assessed using structured questionnaires. A validated questionnaire disclosed three spirituality dimensions: peace, meaning, and faith. In HCWs we investigated the predictors of chronic anxiety (pre-COVID-19 and during the pandemic) and acute anxiety (only during the pandemic), including spirituality in the model. Then, we verified which spirituality dimensions predicted chronic and acute anxiety. Lastly, we studied group differences between the mean scores of these spirituality dimensions.

Material and methods

The study was carried out in a Brazilian Hospital. HCWs (n = 118) were assessed for spirituality at a single time-point. They were also asked about AS that had started pre-COVID-19 and persisted during the pandemic (chronic anxiety), and AS that had started only during the pandemic (acute anxiety). The subjects without chronic anxiety were subdivided into two other groups: acute anxiety and without chronic and acute anxiety. Forward stepwise logistic regressions were used to find the significant AS predictors. First, the model considered sex, age, religious affiliation, and spirituality. Then, the analysis were performed considering only the three spirituality dimensions. Group means differences in the spirituality dimensions were compared using univariate ANCOVAS followed by T-tests.

Results

Spirituality was the most realible predictor of chronic (OR = 0.818; 95%CI:0.752–0.890; p<0.001) and acute anxiety (OR = 0.727; 95%CI:0.601–0.881; p = 0.001). Peace alone predicted chronic anxiety (OR = 0.619; 95%CI:0.516–0.744; p<0.001) while for acute anxiety both peace (OR:0.517; 95%CI:0.340–0.787; p = 0.002), and faith (OR:0.674; 95%CI:0.509–0.892; p = 0.006) significantly contributed to the model. Faith was significantly higher in subjects without AS.

Conclusion

Higher spirituality protected against chronic and acute anxiety. Faith and peace spirituality dimensions conferred protection against acute anxiety during the pandemic.

Slow Coronary Blood Flow: Pathogenesis and Clinical Implications

Coronary slow flow (CSF) phenomenon, also known as cardiac syndrome Y, is defined as the delayed opacification of the coronary vasculature at the distal level. Different hypotheses and theories have been postulated about its substrate and mechanism, such as microvascular and endothelial dysfunction. Several studies have confirmed that CSF is a cause of ischaemia detected by non-invasive testing. Clinically, it can present as angina pectoris, acute coronary syndrome and sudden cardiac death. It has an incidence of 1–5% in patients undergoing coronary angiography and has been most frequently found in young men who are smokers with metabolic syndrome. There are no established treatments for CSF and further studies are still necessary.

Severity, Progress, and Related Factors of Mood Disorders in Patients with Coronary Artery Disease: A Retrospective Study

Patients with coronary artery disease (CAD) are more likely to experience depression and anxiety, which, in turn, are risk factors for CAD. The Beck depression inventory (BDI) and Beck anxiety inventory (BAI) were applied for mood evaluation during hospitalization and again 3 months after discharge in 118 patients with CAD, and cardiopulmonary exercise tests were conducted in the outpatient department. Of the patients diagnosed with CAD, 40 (33.9%) had depressive moods, and 51 (43.2%) had anxious moods. A family history of CAD, low Korean activity scale index (KASI), and use of beta-blockers were independent factors causing depressive mood, while lower left ventricular ejection fraction (LVEF) and low KASI score were independent factors causing anxious mood. A considerable number of patients (35.7% with depressive mood and 25.0% with anxious mood) still had emotional problems after 3 months of discharge. The change values of BDI were associated with lower LVEF and longer hospital stay, while those of BAI was associated with a longer hospital stay. Since some patients had depressive and anxious moods after three months of discharge, evaluating and treating them are essential.