Key result
Higher negative affect was associated with an increased likelihood of reporting chest pain during exercise testing in both ischemic (OR 1.13; 95% CI 1.02-1.26) and nonischemic patients.
Why the study?
Are positive and negative affect associated with chest pain reporting in patients with and without ischemia during exercise testing?
Observational (n=246)
Are positive and negative affect associated with chest pain reporting in patients with and without ischemia during exercise testing?
Higher levels of negative affect are associated with an increased likelihood of reporting chest pain during exercise stress testing, highlighting the role of psychological factors in symptom perception.
Negative affect may influence symptom reporting during stress testing; leaves open causality and whether interventions alter reports.
OBJECTIVE: Silent myocardial ischemia is thought to be associated with worse cardiovascular outcomes due to a lack of perception of pain cues that initiate treatment seeking. Negative affect (NA) has been associated with increased pain reporting and positive affect (PA) with decreased pain reporting, but these psychological factors have not been examined within the context of myocardial ischemia. This study evaluated the associations between PA, NA, and chest pain reporting in patients with and without ischemia during exercise testing. METHODS: A total of 246 patients referred for myocardial perfusion single-photon emission computed tomography exercise stress testing completed the positive and negative affect schedule-expanded version, a measure of PA and NA. Presence of chest pain and myocardial ischemia were evaluated using standardized protocols. RESULTS: Logistic regression analyses revealed that for every 1-point increase in NA, there was a 13% higher chance for ischemic patients (odds ratio [OR] = 1.13; 95% confidence interval [CI] = 1.02 to 1.26) and an 11% higher chance in nonischemic patients (OR = 1.11; 95% CI = 1.03 to 1.19) to report chest pain. A significant interaction of PA and NA on chest pain reporting (β = 0.02; 95% CI = 0.002 to 0.031) was also observed; nonischemic patients with high NA and PA reported more chest pain (57%) versus patients with low NA and low PA (13%), with high NA and low PA (17%), and with high PA and low NA (7%). CONCLUSIONS: Patients who experience higher NA are more likely to report experiencing chest pain. In patients without ischemia, high NA and PA was also associated with a higher likelihood of reporting chest pain. Results suggest that high levels of PA as well as NA may increase the experience and/or reporting of chest pain.
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Stébenne et al. (2016) conducted an observational in Referred for myocardial perfusion SPECT exercise stress testing (n=246). Negative affect (NA) vs. Lower negative affect was evaluated on Chest pain reporting (OR 1.13, 95% CI 1.02 to 1.26). Higher negative affect was associated with an increased likelihood of reporting chest pain during exercise testing in both ischemic (OR 1.13; 95% CI 1.02-1.26) and nonischemic patients.
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