Posttraumatic Stress Disorder, Myocardial Perfusion, and Myocardial Blood Flow: A Longitudinal Twin Study

• Type of Material: Article
• Authors: Viola Vaccarino, Emory University; Amit Shah, Emory University; Valeria Moncayo, Emory University; Jonathon Nye, Emory University; Marina Piccinelli, Emory University; Yi-An Ko, Emory University; Xin Ma, Emory University; Nancy Murrah, Emory University; Lucy Shallenberger, Emory University; Emily Driggers, Emory University; Oleksiy M Levantsevych, Emory University; Muhammad Hammadah, Emory University; Bruno B Lima, Emory University; An Young, Emory University; Wesley O'Neal, Emory University; Mhmtjamil Alkhalaf, Emory University; Ammer Haffar, Emory University; Paolo Raggi, Emory University; Jack Goldberg, US Department of Veterans Affairs Office of Research and Development, Seattle, WA; Nicholas L Smith, US Department of Veterans Affairs Office of Research and Development, Seattle, WA; Ernesto Garcia, Emory University; Arshed Quyyumi, Emory University; James Bremner, Emory University
• Language: English
• Date: 2022-03-07
• Publisher: ELSEVIER SCIENCE INC
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2021 Society of Biological Psychiatry.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.biopsych.2021.09.016
• Title of Journal or Parent Work: BIOLOGICAL PSYCHIATRY
• Volume: 91
• Issue: 7
• Start Page: 615
• End Page: 625
• Grant/Funding Information: This work was supported by the National Institutes of Health (grants R01 HL68630, R01 AG026255, R01 HL125246, R01 HL136205, 2K24 HL077506, K23 HL127251 and T32 HL130025).
• Keywords: Science & Technology; Neurosciences & Neurology; POSITRON-EMISSION-TOMOGRAPHY; RB-82 PET; CORONARY-HEART-DISEASE; DYSFUNCTION; QUANTIFICATION; QUESTIONNAIRE; ATHEROSCLEROSIS; Psychiatry; Neurosciences; Life Sciences & Biomedicine; RISK; ISCHEMIA; NUCLEAR CARDIOLOGY

Abstract

Background: The link between posttraumatic stress disorder (PTSD) and ischemic heart disease remains elusive owing to a shortage of longitudinal studies with a clinical diagnosis of PTSD and objective measures of cardiac compromise. Methods: We performed positron emission tomography in 275 twins who participated in two examinations approximately 12 years apart. At both visits, we obtained a clinical diagnosis of PTSD, which was classified as long-standing (both visit 1 and visit 2), late onset (only visit 2), and no PTSD (no PTSD at both visits). With positron emission tomography, we assessed myocardial flow reserve (MFR), which, in absence of significant coronary stenoses, indexes coronary microvascular function. We compared positron emission tomography data at visit 2 across the three categories of longitudinally assessed PTSD and examined changes between the two visits. Results: Overall, 80% of the twins had no or minimal obstructive coronary disease. Yet, MFR was depressed in twins with PTSD and was progressively lower across groups with no PTSD (2.13), late-onset PTSD (1.97), and long-standing PTSD (1.93) (p =.01). A low MFR (a ratio <2.0) was present in 40% of the twins without PTSD, in 56% of those with late-onset PTSD, and in 72% of those with long-standing PTSD (p <.001). Associations persisted in multivariable analysis, when examining changes in MFR between visit 1 and visit 2, and within twin pairs. Results were similar by zygosity. Conclusions: Longitudinally, PTSD is associated with reduced coronary microcirculatory function and greater deterioration over time. The association is especially noted among twins with chronic, long-standing PTSD and is not confounded by shared environmental or genetic factors.