Psychological and physiological predictors of angina during exercise-induced ischemia in patients with coronary artery disease

Nadine S. Bekkouche, Andrew Wawrzyniak, Kerry S. Whittaker, Mark W. Ketterer, David S. Krantz

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

OBJECTIVE: This study compares sensory-biological, cognitive-emotional, and cognitive-interpretational factors in predicting angina on an exercise treadmill test (ETT). METHODS: A total of 163 patients with ETT-induced ischemia and coronary artery disease in the National Heart, Lung, and Blood Institute Psychophysiological Investigations of Myocardial Ischemia study were given an ETT, during which 79 patients reported angina. We assessed the following as potential predictors of self-reported anginal pain: sensory-biological factors (β-endorphin reactivity, hot pain threshold, and maximal ST-segment depression), cognitive-emotional factors (negative affect and symptom perception), and cognitive-interpretational factors (self-reported history of exercise-induced angina). Models were covariate adjusted with predictors examined individually and as part of component blocks. RESULTS: Logistic regression revealed that history of angina (odds ratio [OR] = 17.41, 95% confidence interval = 7.16-42.34) and negative affect (OR = 1.65, 95% confidence interval = 1.17-2.34), but not maximal ST-segment depression, hot pain threshold, β-endorphin reactivity, or symptom perception, were significant predictors of angina on the ETT. The sensory-biological block was not significantly predictive of anginal pain (χblock = 5.15, p = .741). However, the cognitive-emotional block (χblock = 11.19, p = .004) and history of angina (cognitive-interpretation; χblock = 54.87, p < .001) were predictive of ETT angina. A model including all variables revealed that only history of angina was predictive of ETT pain (OR = 16.39, p < .001), although negative affect approached significance (OR = 1.45, p = .07). CONCLUSIONS: In patients with ischemia, cognitive-emotional and cognitive-interpretational factors are important predictors of exercise angina.

Original languageEnglish
Pages (from-to)413-421
Number of pages9
JournalPsychosomatic Medicine
Volume75
Issue number4
DOIs
StatePublished - May 1 2013
Externally publishedYes

Fingerprint

Exercise Test
Coronary Artery Disease
Ischemia
Exercise
Psychology
Odds Ratio
Endorphins
Pain Threshold
Pain
Psychological
Predictors
Confidence Intervals
National Heart, Lung, and Blood Institute (U.S.)
Neurobehavioral Manifestations
Biological Factors
Myocardial Ischemia
Emotion
History
Logistic Models
Depression

Keywords

  • angina
  • anxiety
  • depression
  • treadmill test

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Applied Psychology
  • Arts and Humanities (miscellaneous)
  • Developmental and Educational Psychology

Cite this

Psychological and physiological predictors of angina during exercise-induced ischemia in patients with coronary artery disease. / Bekkouche, Nadine S.; Wawrzyniak, Andrew; Whittaker, Kerry S.; Ketterer, Mark W.; Krantz, David S.

In: Psychosomatic Medicine, Vol. 75, No. 4, 01.05.2013, p. 413-421.

Research output: Contribution to journalArticle

Bekkouche, Nadine S. ; Wawrzyniak, Andrew ; Whittaker, Kerry S. ; Ketterer, Mark W. ; Krantz, David S. / Psychological and physiological predictors of angina during exercise-induced ischemia in patients with coronary artery disease. In: Psychosomatic Medicine. 2013 ; Vol. 75, No. 4. pp. 413-421.
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AU - Krantz, David S.

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AB - OBJECTIVE: This study compares sensory-biological, cognitive-emotional, and cognitive-interpretational factors in predicting angina on an exercise treadmill test (ETT). METHODS: A total of 163 patients with ETT-induced ischemia and coronary artery disease in the National Heart, Lung, and Blood Institute Psychophysiological Investigations of Myocardial Ischemia study were given an ETT, during which 79 patients reported angina. We assessed the following as potential predictors of self-reported anginal pain: sensory-biological factors (β-endorphin reactivity, hot pain threshold, and maximal ST-segment depression), cognitive-emotional factors (negative affect and symptom perception), and cognitive-interpretational factors (self-reported history of exercise-induced angina). Models were covariate adjusted with predictors examined individually and as part of component blocks. RESULTS: Logistic regression revealed that history of angina (odds ratio [OR] = 17.41, 95% confidence interval = 7.16-42.34) and negative affect (OR = 1.65, 95% confidence interval = 1.17-2.34), but not maximal ST-segment depression, hot pain threshold, β-endorphin reactivity, or symptom perception, were significant predictors of angina on the ETT. The sensory-biological block was not significantly predictive of anginal pain (χblock = 5.15, p = .741). However, the cognitive-emotional block (χblock = 11.19, p = .004) and history of angina (cognitive-interpretation; χblock = 54.87, p < .001) were predictive of ETT angina. A model including all variables revealed that only history of angina was predictive of ETT pain (OR = 16.39, p < .001), although negative affect approached significance (OR = 1.45, p = .07). CONCLUSIONS: In patients with ischemia, cognitive-emotional and cognitive-interpretational factors are important predictors of exercise angina.

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