What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Suspected ischemic heart disease (n=256). Intervention: Myocardial ischemia during cardiac stress testing vs. No myocardial ischemia. Primary outcome: Facial expression of sadness during start of cardiac stress testing (d = 0.34, p=0.017).

February 23, 2021Open Access

Facial Expressions of Emotions During Pharmacological and Exercise Stress Testing: the Role of Myocardial Ischemia and Cardiac Symptoms

Key Result

Myocardial ischemia during cardiac stress testing was associated with significantly higher facial expressions of sadness (d = 0.34) and lower happiness (d = 0.30) compared to no ischemia.

Study Design

Type

Cross-Sectional (n=256)

Multicenter

Structured PICO

Do myocardial ischemia and anginal symptoms increase negative facial emotion expressions in patients undergoing cardiac stress testing?

Population

256 patients (mean age 66.8 years, 43% female) undergoing cardiac stress testing with myocardial perfusion imaging for suspected ischemic heart disease.

Exposure

Presence of myocardial ischemia and/or anginal symptoms during cardiac stress testing (bicycle exercise or adenosine with myocardial perfusion imaging).

Comparator

Absence of myocardial ischemia and/or anginal symptoms during cardiac stress testing.

Outcome

Facial expressions of emotions (sadness, anxiety, anger, and happiness) analyzed at baseline, initial CST, maximal CST, and recovery using FaceReader software.surrogate

Main Result

Standardized Mean Difference: 0.34

Absolute Event Rate: 14.43% vs 9.75%

p-value: p=0.017

Limitations

Heterogeneous patient sample without subgrouping by underlying coronary obstructions or extensive cardiac history
Individual differences in pain thresholds may have affected symptom reporting
Gender differences were not specifically taken into account in the statistical analyses
Self-reported emotion measure was limited to anxiety/tension
Hospital setting may have attenuated facial expressiveness

Abstract

Abstract Background Negative emotions have been linked to ischemic heart disease, but existing research typically involves self-report methods and little is known about non-verbal facial emotion expression. The role of ischemia and anginal symptoms in emotion expression was examined. Methods Patients undergoing cardiac stress testing (CST) using bicycle exercise or adenosine with myocardial perfusion imaging were included ( N = 256, mean age 66.8 ± 8.7 year., 43% women). Video images and emotion expression (sadness, anxiety, anger, and happiness) were analyzed at baseline, initial CST , maximal CST, recovery. Nuclear images were evaluated using SPECT. Results Ischemia ( N = 89; 35%) was associated with higher levels of sadness ( p = .017, d = 0.34) and lower happiness ( p = .015, d = 0.30). During recovery, patients with both ischemia and anginal symptoms had the highest sadness expression ( F (3,254) = 3.67, p = .013, eta 2 = 0.042) and the lowest happiness expression ( F (3, 254) = 4.19, p = .006, eta 2 = .048). Conclusion Sadness and reduced happiness were more common in patients with ischemia. Also, anginal symptoms were associated with more negative emotions.

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