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

Maria T Bekendam,Paula M C Mommersteeg,Ilse A C Vermeltfoort,Willem J Kop,Jos W Widdershoven

doi:10.1007/s12529-021-09963-3

Maria T Bekendam, Paula M C Mommersteeg + Show 3 more

Open Access

https://doi.org/10.1007/s12529-021-09963-3

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Abstract

BackgroundNegative 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.MethodsPatients 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.ResultsIschemia (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).ConclusionSadness and reduced happiness were more common in patients with ischemia. Also, anginal symptoms were associated with more negative emotions.

Highlights

Negative psychological factors such as depression, anxiety, and anger are common in patients with ischemic heart disease [1,2,3]
Referral for cardiac stress testing (CST) was based on clinical factors.The project was conducted at Institute Verbeeten, Tilburg, the Netherlands between January 2017 and December 2018
No significant differences in left ventricular ejection fraction (LVEF) were found between patients with versus without ischemia

Summary

Introduction

Negative psychological factors such as depression, anxiety, and anger are common in patients with ischemic heart disease [1,2,3]. These psychological factors are known to adversely affect clinical outcomes in cardiac patients [1, 2, 4]. It is possible that another pathway is important in which myocardial ischemia results in a lower threshold for the experience and expression of negative emotions, but this direction of the association is much less well investigated. Video images and emotion expression (sadness, anxiety, anger, and happiness) were analyzed at baseline, initial CST , maximal CST, recovery.

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Conclusion