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. 2021 Dec;28(6):692-704.
doi: 10.1007/s12529-021-09963-3. Epub 2021 Feb 23.

Facial Expressions of Emotions During Pharmacological and Exercise Stress Testing: the Role of Myocardial Ischemia and Cardiac Symptoms

Maria T Bekendam  1 , Willem J Kop  1 , Ilse A C Vermeltfoort  2 , Jos W Widdershoven  1   3 , Paula M C Mommersteeg  4
Affiliations

Facial Expressions of Emotions During Pharmacological and Exercise Stress Testing: the Role of Myocardial Ischemia and Cardiac Symptoms

Maria T Bekendam et al. Int J Behav Med. 2021 Dec.

Abstract

Background: Negative emotions have been linked to ischemic heart disease, but existing research typically involves self-report methods and little is known about non-verbal facial emotion expression. The role of ischemia and anginal symptoms in emotion expression was examined.

Methods: Patients undergoing cardiac stress testing (CST) using bicycle exercise or adenosine with myocardial perfusion imaging were included (N = 256, mean age 66.8 ± 8.7 year., 43% women). Video images and emotion expression (sadness, anxiety, anger, and happiness) were analyzed at baseline, initial CST , maximal CST, recovery. Nuclear images were evaluated using SPECT.

Results: Ischemia (N = 89; 35%) was associated with higher levels of sadness (p = .017, d = 0.34) and lower happiness (p = .015, d = 0.30). During recovery, patients with both ischemia and anginal symptoms had the highest sadness expression (F (3,254) = 3.67, p = .013, eta2 = 0.042) and the lowest happiness expression (F (3, 254) = 4.19, p = .006, eta2 = .048).

Conclusion: Sadness and reduced happiness were more common in patients with ischemia. Also, anginal symptoms were associated with more negative emotions.

Keywords: Cardiac stress testing; Cardiac symptoms; Emotions; Face reader software; Myocardial ischemia; Myocardial perfusion imaging.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Emotions during CST in patient with versus without ischemia. Data indicate the facial expression of the four emotions (sadness, anxiety, anger, and happiness) at rest, start of CST, maximum CST, and recovery. Error bars indicate standard error of the mean. *p < 0.05
Fig. 2
Fig. 2
Facial expression of sadness and happiness during recovery of CST for the four ischemia/angina groups. Data are the mean levels of expressed sadness and happiness for four patient groups: (1) without ischemia and no anginal symptoms (reference group: N = 110), (2) with cardiac complaints but no ischemia (non-ischemic complaints: N = 57), with ischemia but without anginal symptoms (silent ischemia: N = 61), and with both ischemia and anginal symptoms (symptomatic ischemia: N = 28). Error bars indicate standard error of the mean. A p = presence of angina reported during CST
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