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Author Notes:

Amit J. Shah, MD, MSCR, Emory University, 1518 Clifton Road NE, Room 3053, Atlanta, GA 30322. E‐mail: ajshah3@emory.edu

We acknowledge the MIPS staff for their tireless work in recruiting patients, conducting the study, and assembling the data set. We would also like to acknowledge the Emory Discovery program for its support in providing Ms. Weeks with her protected time. We would like to thank several affiliated institutions, including the Atlanta Veterans Affairs Medical Center, Emory Program in Cardiovascular Outcomes Research and Epidemiology (EPICORE), the Emory Clinical Cardiovascular Institute (ECCRI), and Atlanta Clinical and Translational Science Institute (ACTSI).

Disclosures: None.


Research Funding:

This work was supported by the National Institutes of Health (K23HL 127251, R03 HL146879, K24HL077506, K24MH076955, KL2TR000455, R01 HL68630, R01 AG026255, R01 HL109413, P01 HL101398, and T32HL130025); and by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR000454.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Cardiac & Cardiovascular Systems
  • Cardiovascular System & Cardiology
  • psychological stress
  • repolarization heterogeneity
  • sudden cardiac death risk
  • RISK

Early Life Trauma Is Associated With Increased Microvolt T-Wave Alternans During Mental Stress Challenge: A Substudy of Mental Stress Ischemia: Prognosis and Genetic Influences

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Journal Title:



Volume 11, Number 5


, Pages e021582-e021582

Type of Work:

Article | Final Publisher PDF


BACKGROUND: Early life trauma has been associated with increased cardiovascular risk, but the arrhythmic implications are unclear. We hypothesized that in patients with coronary artery disease, early life trauma predicts increased arrhythmic risk during mental stress, measured by elevated microvolt T-wave alternans (TWA), a measure of repolarization heterogeneity and sudden cardiac death risk. METHODS AND RESULTS: In a cohort with stable coronary artery disease (NCT04123197), we examined early life trauma with the Early Trauma Inventory Self Report-Short Form. Participants underwent a laboratory-based mental stress speech task with Holter monitoring, as well as a structured psychiatric interview. We measured TWA during rest, mental stress, and recovery with ambulatory electrocardiographic monitoring. We adjusted for sociodemographic factors, cardiac history, psychiatric comorbidity, and hemodynamic stress reactivity with multivariable linear regression models. We examined 320 participants with noise-and arrhythmia-free ECGs. The mean (SD) age was 63.8 (8.7) years, 27% were women, and 27% reported significant childhood trauma (Early Trauma Inventory Self Report-Short Form ≥10). High childhood trauma was associated with a multivariable-adjusted 17% increase in TWA (P=0.04) during stress, and each unit increase in the Early Trauma Inventory Self Report-Short Form total score was associated with a 1.7% higher stress TWA (P=0.02). The largest effect sizes were found with the emotional trauma subtype. CONCLUSIONS: In a cohort with stable coronary artery disease, early life trauma, and in particular emotional trauma, is associated with increased TWA, a marker of increased arrhythmic risk, during mental stress. This association suggests that early trauma exposures may affect long-term sudden cardiac death risk during emotional triggers, although more studies are warranted.

Copyright information:

© 2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (https://creativecommons.org/licenses/by-nc-nd/4.0/rdf).
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