THE IMPACT OF TYPE D PERSONALITY ON THE SEVERITY OF CORONARY ARTERY DISEASE

Abstract

Associations between depression and anxiety with cardiovascular disease have been established in the general population. Our research aimed to analyze the relationship of type D personality (TDP) conceived by Denollet (Psychosom Med 2005;67:89–97) and the severity of coronary artery disease (CAD). This cross sectional study involved 161 patients with CAD (>50% stenosis of at least one major epicardial coronary artery). DS-14 scale for TDP and its components (Negative Affectivity and Social Inhibition) were administered in studied subjects. According to TDP, patients with CAD were divided into two groups: group 1 without TDP and group 2 with TDP. SYNTAX scores were assessed according to the angiographic results. To assess the impact on the myocardial function, several echocardiographic parameters were determined: left ventricular ejection fraction (LVEF), left atrial volume (LAV), the peak early diastolic transmitral velocity/peak early mitral annular diastolic velocity (by using the average of the velocities from medial and lateral corners of the mitral annulus) ratio (E/E’), peak systolic mitral annular velocity (S’) and LV global longitudinal strain (GLS). Of our patients, 32 (19.9%) presented TDP (group 2). The mean age was 58±11 years in group 1 and 57±9 years in group 2 (p=0.73). There were no significant differences between the two groups regarding sex, hypertension, diabetes, dyslipidemia, smoking (all p>0.05). Group 2 presented a higher Syntax score (25.8±12.2 vs. 14.2±7.9, p<0.001). More patients of group 2 presented myocardial infarction than of group 1 (22/32, 68.7% vs. 46/129, 35.6%, p=0.001). Group 2 presented more important systolic and diastolic dysfunction: lower LVEF (45.7±14.2 vs. 51.6±9.1 %, p=0.005), lower S’ (6.5±2.5 vs. 9.2±3.2 cm/s, p=0.005), higher GLS (-13.2±5.6 %, vs. -16.6±5.1, p<0.001), higher E/E’ ratio (14.1±4.2 vs. 9.5±3.2 %, p=0.003) and higher LAV (88.6±34.1 vs. 71.3±27.3 ml, p=0.003). The receiver operating characteristic curve analysis revealed that TDP was a strong indicator of high SYNTAX score (>32) with an area under the curve (AUC) of 0.87 (95% confidence interval, 0.76-0.99, p<0.001). TDP was a better indicator of high SYNTAX score (higher AUC values) when compared to age, sex, hypertension, smoking, diabetes, dyslipidemia, LAV, LVEF, S’, E/E’ or GLS (all p<0.05). This preliminary study indicated that patients with TDP presented more complex and sever CAD, more important LV systolic and diastolic dysfunction, and TDP was found to be a good predictor for high SYNTAX score.