Relations Between Depressive Symptoms, Anxiety, and T Wave Abnormalities in Subjects Without Clinically-Apparent Cardiovascular Disease (from the Multi-Ethnic Study of Atherosclerosis [MESA])

doi:10.1016/j.amjcard.2014.09.034

The American Journal of Cardiology

Volume 114, Issue 12, 15 December 2014, Pages 1917-1922

https://doi.org/10.1016/j.amjcard.2014.09.034 Get rights and content

Highlights

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We examined the relation of abnormal repolarization to depressive and anxiety symptoms.
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Elevated depressive symptoms were associated with increased odds of T wave inversions.
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Greater trait anxiety was associated with a reduced odds of T wave inversions.
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Negative emotions may have unique relations with cardiac repolarization.

The aim of this study was to test the hypothesis that depression and anxiety are associated with electrocardiographic (ECG) repolarization abnormalities in the Multi-Ethnic Study of Atherosclerosis (MESA), a cohort free of symptomatic cardiovascular disease. Depressive symptoms were assessed by using the Center for Epidemiologic Studies Depression Scale and trait anxiety symptoms by using the Spielberger State-Trait Anxiety Inventory; both were categorized according to uppermost quartile. T-wave inversions in ECG leads other than V₁ to V₃ were obtained from electrocardiograms obtained at rest during the baseline examination. Participants with major intraventricular conduction abnormalities and those taking antiarrhythmics, antidepressants, and/or antipsychotics were excluded. Logistic regression models were estimated with multivariable adjustment for traditional cardiovascular disease risk factors. Among 5,906 participants, elevated depressive symptoms were associated with increased odds of T-wave inversion after multivariable adjustment (odds ratio 2.02, 95% confidence interval 1.33 to 3.06, p = 0.001), whereas greater trait anxiety was associated with reduced odds of T-wave inversion (odds ratio 0.47, 95% confidence interval 0.29 to 0.77, p = 0.003). The divergent associations of depressive symptoms and trait anxiety with ECG T-wave inversions were similar in men and women, and these associations were present across the racial and ethnic subgroups (non-Hispanic white, African-American, Hispanic, and Chinese). In conclusion, symptoms of depression and anxiety were independently yet oppositely associated with ECG T-wave inversions. Negative emotions may have a differential impact on cardiovascular mortality through unique relations with cardiac repolarization.

Section snippets

Methods

MESA is a multicenter, longitudinal cohort study of the prevalence, correlates, and progression of subclinical cardiovascular disease.⁵ MESA recruited 6,814 men and women 45 to 84 year of age, self-identified as white, black, Hispanic, or Chinese, and free of clinically apparent cardiovascular disease from July 2000 to August 2002 from 6 communities: Baltimore City and Baltimore County, Maryland; Chicago, Illinois; Forsyth County, North Carolina; Los Angeles County, California; northern

Results

After excluding participants with QRS durations ≥120 ms and those taking antiarrhythmic, antidepressant, and/or antipsychotic medications, our sample consisted of 5,906 participants. Participants included in the analysis were younger (average age 62 vs 63.2 years), less likely to be non-Hispanic white (35.6% vs 56.9%), and more likely to be Chinese-American, Hispanic, or African-American than participants who were excluded (Supplementary Table 1). Included participants had fewer coronary

Discussion

In this sample of men and women without known cardiovascular disease, elevated depressive symptoms were associated with increased odds of ECG T-wave inversions in leads other than V₁ to V₃, and elevated trait anxiety symptoms were associated with decreased odds of T-wave inversions. The divergent associations of depressive symptoms and anxiety with T-wave inversions may seem surprising, given their moderate correlation, but they were generally preserved across gender and racial and ethnic

Acknowledgment

The authors thank the other investigators, the staff members, and the participants of the MESA study for their valuable contributions. A full list of participating MESA investigators and institutions can be found at http://www.mesa-nhlbi.org.

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Cited by (4)

Association of positive well-being with reduced cardiac repolarization abnormalities in the First National Health and Nutrition Examination Survey
2018, International Journal of Cardiology
Citation Excerpt :
This study uniquely examined general well-being scale in association with repolarization abnormalities as a proxy for sudden cardiac death risk, while other studies have exclusively focused on the relationship of negative mood with repolarization and/or SCD. Whang et al. found that elevated depressive symptoms were associated with an increased odds of having T wave inversions [23]. Empana et al. also found an association between clinical depression and sudden cardiac death in the community [24].
The mechanisms by which psychological factors may influence possibly arrhythmia risk are not known. We hypothesized that psychological wellness, measured by the General Well-Being Schedule (GBWS), is associated with less repolarization heterogeneity as measured by T-axis. We also explored whether T-axis was a mediator in the relationship of GWBS with adverse cardiac outcomes.
We studied 5533 adults aged 25–74 years without a history of CVD from NHANES I (National Health and Nutrition Examination Survey) (1971–75). Frontal T-axis was obtained through 12-lead ECG and characterized as normal (15° to 75°), borderline (−15° to 15° or 75° to 105°) or abnormal (>105° or <−15°).
The mean ± SD age was 43.1 ± 11.5 years and 55% were women. A 1-SD increase in GWBS score associated with a 23% reduced odds of abnormal T-axis (p < 0.001) and 11% lower hazard of composite CHD hospitalization and death (p = 0.02). When adjusting for sociodemographic factors, health behaviors, and CHD risk factors, the association was minimally changed and remained statistically significant. Additional adjustment for T-axis did not change the relationship with outcomes.
General well-being is independently associated with less abnormal frontal T-axis and CHD events in otherwise healthy individuals.
Selected psychological comorbidities in coronary heart disease: Challenges and grand opportunities
2018, American Psychologist
Association between depression, anxiety, and antidepressant use with T-Wave amplitude and QT-interval
2018, Frontiers in Neuroscience
An electrocardiogram-based risk equation for incident cardiovascular disease from the National Health and Nutrition Examination Survey
2016, JAMA Cardiology

: This research was supported by Contracts N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168, and N01-HC-95169 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland, and by Grants UL1-TR-000040 and UL1-TR-001079 from the National Center for Research Resources, Bethesda, Maryland. Dr. Whang is supported by a Scientist Development Grant (10SDG3720001) from the AHA Founders Affiliate. Dr. Nazarian is supported by Grants K23HL089333 and R01HL116280 from the National Institutes of Health, Bethesda, Maryland, and is a principal investigator for research support to Johns Hopkins from Biosense Webster Inc., Diamond Bar, California. Dr. Alcantara is supported by Grant R01HL115941-01S1 from the NIH. Dr. Shah is supported by Grants UL1TR000454 and KL2TR000455 from the NIH. Dr. Davidson is supported by Grants HL114924, HL088117, and HL084034 from the NIH.

: See page 1921 for disclosure information.

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MiscellaneousRelations Between Depressive Symptoms, Anxiety, and T Wave Abnormalities in Subjects Without Clinically-Apparent Cardiovascular Disease (from the Multi-Ethnic Study of Atherosclerosis [MESA])

Highlights

Section snippets

Methods

Results

Discussion

Acknowledgment

Am J Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

JACC Cardiovasc Imaging

Am J Cardiol

Int J Cardiol

J Am Coll Cardiol

J Psychosom Res

QTc prolongation measured by standard 12-lead electrocardiography is an independent risk factor for sudden death due to cardiac arrest

Circulation

Prevalence and prognostic significance of T-wave inversions in right precordial leads of a 12-lead electrocardiogram in the middle-aged subjects

Circulation

Multi-Ethnic Study of Atherosclerosis: objectives and design

Am J Epidemiol

Miscellaneous
Relations Between Depressive Symptoms, Anxiety, and T Wave Abnormalities in Subjects Without Clinically-Apparent Cardiovascular Disease (from the Multi-Ethnic Study of Atherosclerosis [MESA])