Anxiety and hemodynamic reactivity during cardiac stress testing: The role of gender and age in myocardial ischemia

Abstract

Background: The prevalence of myocardial ischemia is associated with anxiety. State and trait anxiety are more common in younger women compared to men, and high anxiety levels could affect hemodynamic reactivity during cardiac stress testing. The aim is to examine whether anxiety plays a role in gender differences in patients ≤ 65 and > 65 years in hemodynamic reactivity and ischemia during cardiac stress testing.

Methods and results: Included were 291 patients (66.8 ± 8.7 years, 45% women) with suspect ischemia undergoing myocardial perfusion single-photon emission computed tomography (MPI-SPECT). Primary outcomes were semi-quantitative summed difference score (SDS) and summed stress score (SSS), as continuous indicators of myocardial ischemia. Analyses were stratified by age. Trait anxiety was measured using a validated questionnaire (GAD-7) and state anxiety using facial expression analyses software. Overall, trait and state anxiety were not associated with the prevalence of ischemia (N = 107, 36%). A significant interaction was found between gender and trait anxiety in women ≤ 65 years for SDS (F(1,4) = 5.73, P = .019) and SSS (F(1,10) = 6.50, P = .012). This was not found for state anxiety.

Conclusion: SDS and SSS were significantly higher in women younger than 65 years with high trait anxiety. This interaction was not found in men and women over 65 years.

Keywords: Age; Cardiac stress testing; Myocardial ischemia; Sex differences; Trait anxiety.

Figure 1

Summed Difference Score (SDS, square root transformed) stratified for trait anxiety (high/low), gender and age groups. The presence of ischemia is presented in the bar graphs as % per subgroup

Figure 2

Summed Stress Score (SSS, square root transformed) stratified for trait anxiety (high/low), gender and age groups. The presence of ischemia presented in the bar graphs as % per subgroup