Physician burnout and type D personality relate to pericoronary fat phenotype and role of sympathetic activation: a cross-sectional study

Figures

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  Fig. 1. Directed acyclic graph illustrating the hypothesized associations between psychosocial exposures—Type D personality [TDP; interaction between negative affectivity (NA) and social inhibition (SI), controlled for main effects of NA and SI)] and burnout—and pericoronary adipose tissue (PCAT) attenuation (primary outcome). Peak rate-pressure product (RPP) during the cold pressor test is modeled as a potential statistical mediator (indirect effect) in these associations. Additionally, PCAT attenuation moderates the association between peak RPP and serum C-reactive protein (CRP), which is evaluated as an exploratory downstream outcome. Covariates [Systematic Coronary Risk Evaluation 2 (SCORE2), body mass index (BMI), waist circumference (WC), age] are adjusted for to account for confounding.

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  Fig. 2. The partial regression plots with fitted lines depict the multivariable associations between continuous social inhibition (SI) scores and total pericoronary adipose tissue (PCAT) attenuation (Panel A) and peak rate pressure product (RPP) (Panel B), stratified by participants with high versus low negative affectivity (NA) scores based on a median split. Panel A model: NA × SI interaction term for total PCAT attenuation: B = − 0.044; p = 0.011; ΔR2 = 0.102. Panel B model: NA × SI interaction term for peak RPP: B = 0.002; p = 0.013; ΔR2 = 0.093. The analyses were adjusted for burnout and Systematic Coronary Risk Evaluation 2.

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  Fig. 3. The figure presents the indirect effect model, adjusted for burnout and SCORE2, and includes the main effects of continuous negative affectivity (NA) and social inhibition (SI) scores as covariates. Path a represents the association of the NA × SI with peak rate pressure product (RPP) per 10,000 units. Path b reflects the association of an increase of 10,000 units in peak RPP with total pericoronary adipose tissue (PCAT) attenuation. Path c indicates the total association of the NA × SI interaction with total PCAT attenuation without accounting for peak RPP, while path c’ shows the corresponding association when peak RPP is included in the model. The reduction from path c to path c′ is statistically consistent with partial mediation by peak RPP. Asterisks (*) indicate statistically significant associations (all p < 0.05).

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  Fig. 4. The partial regression plot with fitted line depicts the multivariable relationship between the continuous measure of peak rate pressure product (RPP) and high-sensitivity C-reactive protein (CRP), stratified by participants with low versus high total pericoronary adipose tissue (PCAT) attenuation, based on a median split. The analyses were adjusted for burnout, the Systematic Coronary Risk Evaluation 2, the main effects of negative affectivity and social inhibition, and the negative affectivity-by-social inhibition interaction. Interaction term (peak RPP × total PCAT attenuation): B = − 0.200; p = 0.023; ΔR2 = 0.080.