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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 (χ(2)block = 5.15, p = .741). However, the cognitive-emotional block (χ(2)block = 11.19, p = .004) and history of angina (cognitive-interpretation; χ(2)block = 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.

Titel:	Psychological and physiological predictors of angina during exercise-induced ischemia in patients with coronary artery disease.
Autor/in / Beteiligte Person:	Bekkouche, NS ; Wawrzyniak, AJ ; Whittaker, KS ; Ketterer, MW ; Krantz, DS
Zeitschrift:	Psychosomatic medicine, Jg. 75 (2013-05-01), Heft 4, S. 413-21
Veröffentlichung:	Hagerstown, MD : Lippincott Williams & Wilkins ; <i>Original Publication</i>: Baltimore [etc.], 2013
Medientyp:	academicJournal
ISSN:	1534-7796 (electronic)
DOI:	10.1097/PSY.0b013e31828c4cb4
Schlagwort:	Adult Aged Aged, 80 and over Angina Pectoris physiopathology Angina Pectoris psychology Anxiety complications Comorbidity Coronary Disease complications Coronary Disease psychology Depression complications Electrocardiography Female Hot Temperature adverse effects Humans Male Middle Aged Models, Cardiovascular Models, Neurological Pain Threshold Recurrence Risk Factors Self Concept Self Report beta-Endorphin blood Angina Pectoris etiology Coronary Disease physiopathology Exercise Test
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: English Publication Type: Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, Non-P.H.S. Language: English [Psychosom Med] 2013 May; Vol. 75 (4), pp. 413-21. <i>Date of Electronic Publication: </i>2013 Apr 10. MeSH Terms: Exercise Test* ; Angina Pectoris / etiology ; Coronary Disease / physiopathology ; Adult ; Aged ; Aged, 80 and over ; Angina Pectoris / physiopathology ; Angina Pectoris / psychology ; Anxiety / complications ; Comorbidity ; Coronary Disease / complications ; Coronary Disease / psychology ; Depression / complications ; Electrocardiography ; Female ; Hot Temperature / adverse effects ; Humans ; Male ; Middle Aged ; Models, Cardiovascular ; Models, Neurological ; Pain Threshold ; Recurrence ; Risk Factors ; Self Concept ; Self Report ; beta-Endorphin / blood References: Am J Med. 1985 Sep 13;79(3A):18-24. (PMID: 4050821) ; J Neurol Neurosurg Psychiatry. 1976 Nov;39(11):1071-5. (PMID: 188989) ; Am Heart J. 1999 Mar;137(3):528-35. (PMID: 10047637) ; Circulation. 2002 Apr 16;105(15):1780-4. (PMID: 11956119) ; Am Heart J. 2001 Nov;142(5):864-71. (PMID: 11685176) ; Br Heart J. 1985 Jul;54(1):22-6. (PMID: 4015912) ; Pain. 1986 Aug;26(2):199-209. (PMID: 3763233) ; Am J Cardiol. 1996 Jan 1;77(1):1-4. (PMID: 8540443) ; Circulation. 2012 Jan 3;125(1):188-97. (PMID: 22215894) ; Eur Heart J. 1988 Dec;9 Suppl N:25-33. (PMID: 3246253) ; Circulation. 1996 Nov 15;94(10):2402-9. (PMID: 8921780) ; Am J Cardiol. 1996 Aug 1;78(3):266-70. (PMID: 8759802) ; Pain. 1975 Sep;1(3):277-299. (PMID: 1235985) ; Psychol Bull. 2001 Sep;127(5):599-617. (PMID: 11548969) ; Psychosom Med. 2006 Mar-Apr;68(2):217-23. (PMID: 16554386) ; Psychother Psychosom. 2004 Nov-Dec;73(6):344-52. (PMID: 15479989) ; J Am Coll Cardiol. 1999 May;33(6):1476-84. (PMID: 10334411) ; Circulation. 2009 Jul 14;120(2):126-33. (PMID: 19564560) ; Int J Epidemiol. 1989 Sep;18(3):607-13. (PMID: 2807664) ; Am J Cardiol. 1997 Apr 1;79(7):889-92. (PMID: 9104900) ; Circ J. 2009 May;73(5):785-97. (PMID: 19282605) ; Eur Arch Psychiatry Clin Neurosci. 2003 Dec;253(6):313-20. (PMID: 14714121) ; J Am Coll Cardiol. 1990 Nov;16(5):1120-4. (PMID: 2229758) ; J Dent Educ. 2001 Dec;65(12):1378-82. (PMID: 11780656) ; Circulation. 2003 Sep 9;108(10):1263-77. (PMID: 12963683) ; Am Heart J. 1994 Oct;128(4):703-12. (PMID: 7942441) ; Cardiovasc Psychiatry Neurol. 2011;2011:134040. (PMID: 22175000) ; JAMA. 2003 Jul 9;290(2):215-21. (PMID: 12851276) ; Psychosom Med. 1991 Jan-Feb;53(1):13-24. (PMID: 2011647) ; N Engl J Med. 1984 Nov 1;311(18):1144-7. (PMID: 6482932) ; Pain. 1999 Aug;Suppl 6:S121-S126. (PMID: 10491980) ; Cardiol Rev. 2011 May-Jun;19(3):130-42. (PMID: 21464641) ; J Am Coll Cardiol. 1999 Jun;33(7):1855-62. (PMID: 10362185) ; Neuroreport. 1996 Aug 12;7(12):1982-4. (PMID: 8905708) ; Eur J Pain. 2004 Dec;8(6):525-31. (PMID: 15531220) ; Am J Cardiol. 1986 Oct 1;58(9):667-72. (PMID: 2945417) ; Psychosom Med. 1998 Jan-Feb;60(1):56-63. (PMID: 9492241) ; Pain. 1991 Dec;47(3):319-324. (PMID: 1784502) ; Am J Cardiol. 1986 Sep 1;58(6):428-30. (PMID: 2944365) ; Pain. 1976 Sep;2(3):309-313. (PMID: 800252) ; Pain. 1996 Mar;64(3):477-483. (PMID: 8783312) ; Am J Cardiol. 1987 Apr 1;59(8):735-9. (PMID: 3030088) ; J Pers. 1987 Jun;55(2):299-316. (PMID: 3612472) ; Neurogastroenterol Motil. 2007 Jan;19(1 Suppl):29-46. (PMID: 17280584) ; Heart. 2002 Nov;88(5):441-3. (PMID: 12381620) ; Br J Prev Soc Med. 1977 Mar;31(1):42-8. (PMID: 856370) ; Psychol Sci Public Interest. 2010 Aug;11(2):53-79. (PMID: 26168413) ; J Abnorm Psychol. 1958 May;56(3):367-73. (PMID: 13538604) ; Pain Res Manag. 2002 Spring;7(1):21-30. (PMID: 16231064) ; Bull World Health Organ. 1962;27:645-58. (PMID: 13974778) ; Pain. 2010 Jun;149(3):501-505. (PMID: 20382477) ; J Am Coll Cardiol. 1997 Apr;29(5):948-54. (PMID: 9120180) ; Science. 1965 Nov 19;150(3699):971-9. (PMID: 5320816) ; Am J Cardiol. 1993 Sep 15;72(9):715-20. (PMID: 8249851) ; Am Heart J. 1984 Jul;108(1):150-8. (PMID: 6731265) Grant Information: R01 HL085730 United States HL NHLBI NIH HHS; 1R01 HL085730 United States HL NHLBI NIH HHS Contributed Indexing: Keywords: angina; anxiety; depression; treadmill test Substance Nomenclature: 60617-12-1 (beta-Endorphin) Entry Date(s): Date Created: 20130412 Date Completed: 20131217 Latest Revision: 20220317 Update Code: 20231215 PubMed Central ID: PMC3646947

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