Association of Posttraumatic Stress Disorder with Cardiac Electrical Instability: A Twin Study

创伤后应激障碍与心脏电不稳定的关联：一项双胞胎研究

• 批准号: 10642783
• 负责人: Amit Jasvant Shah
• 金额: $ 69.22万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10642783
• 关键词: Accelerometer; Acute; Acute Post Traumatic Stress Disorder; Address; Age; Area; Arrhythmia; Attenuated; Autonomic Dysfunction; Autopsy; Behavioral; Behavioral Mechanisms; Brain; Cardiac; Cardiac Electrophysiologic Techniques; Cardiomyopathies; Cardiovascular system; Chronic; Chronic Post Traumatic Stress Disorder; Collaborations; Communities; Coronary heart disease; Country; Data; Diagnosis; Ecological momentary assessment; Electrocardiogram; Event; Exposure to; Feasibility Studies; Funding; Future; General Population; Genes; Genetic; Health Technology; Heart; Heart Diseases; Heterogeneity; Home; Individual; International; Interview; Investigation; Lead; Machine Learning; Measures; Medical center; Methodology; Methods; Monitor; Monozygotic twins; Morphology; Natural experiment; Outcome; Participant; Physical activity; Pilot Projects; Polysomnography; Post-Traumatic Stress Disorders; Prevalence; Protocols documentation; Psyche structure; Psychological Stress; Publications; Recurrence; Registries; Research; Research Design; Research Personnel; Risk; Risk Factors; Risk Marker; Sampling; Savings; Sex Differences; Site; Sleep; Sleep Fragmentations; Sleep disturbances; Social Distance; Stress; Symptoms; Tachyarrhythmias; Techniques; Time; Travel; Twin Multiple Birth; Twin Studies; United States; United States Department of Veterans Affairs; Ventricular; Veterans; Vietnam; Viola; Woman; Work; adjudication; behavior influence; biobehavior; clinical diagnosis; cohort; cost; design; experience; heart rate variability; improved; indexing; innovation; mHealth; maladaptive behavior; male; men; modifiable behavior; mortality risk; multidisciplinary; novel; participant enrollment; physical inactivity; poor sleep; prospective; psychological trauma; recruit; sedentary lifestyle; signal processing; sleep behavior; sudden cardiac death; telehealth; traumatic stress; virtual

ABSTRACT Psychological stress is a potentially major risk factor for sudden cardiac death (SCD), but unfortunately not studied very well. This may in part be is due to the fact that many SCDs are unwitnessed, which makes the study of SCD triggers difficult. As a possible solution to this problem, we propose to study electrocardiographic (ECG) markers of cardiac electrical instability in a cohort of 1,000 Veteran male twins who are recruited from the Vietnam Era Twin Registry. Dr. Shah is an Early Stage Investigator who is poised to lead this effort that follows from his previous work on arrhythmia risk due to acute mental stress (K23 HL127251). His team includes several established investigators in the field of PTSD and heart disease (Viola Vaccarino, Douglas Bremner), stress and arrhythmia (Rachel Lampert), and signal processing/mobile health technologies (Gari Clifford, Larry Jamner). Dr. Shah, over the past several years, has worked closely with the Vietnam veteran twins and is an experienced investigator with this cohort. They have generated important preliminary data that demonstrates a potential relationship between PTSD and TWA; in addition, they have demonstrated feasibility of studying Veterans continuously for one week in their currently funded study which measures PTSD, autonomic function, and sleep. Dr. Shah is also leading telehealth efforts at the Atlanta Veterans Affairs Medical Center, which has provided important methodologies for the current study to recruit and enroll participants from around the United States remotely. The first aim seeks to evaluate the relationship of PTSD symptoms and cardiac electrical instability using two ECG-based markers for arrhythmia: microvolt T-wave alternans (TWA) and morphological beat variability (MVB). Both are expected to be associated with higher PTSD symptoms, suggesting an acutely increased risk of sudden cardiac death. The relationship is also hypothesized to be moderated by genetic factors: when adjusting for genetic factors by evaluating monozygotic twin pairs discordant for PTSD, the relationship is attenuated. Aim 2 examines the relationship between everyday PTSD symptoms with an ecological momentary assessment and MVB/TWA. We hypothesize that acute increases in PTSD symptoms and stress also increase cardiac electrical instability, measured by higher TWA and MVB. Finally, aim 3 explores fragmented sleep and other behavioral correlates of PTSD as possible mechanisms through which PTSD may indirectly impact SCD risk through modifiable behaviors. Our hypothesis is that sleep fragmentation and other maladaptive behaviors such as low physical activity will result higher TWA/MVB on a daily basis. Overall, Dr. Shah is a poised and well-equipped to carry out this large project with novel methods and unprecedented reach in terms of impact and

抽象的 心理压力是心源性猝死（SCD）的潜在主要危险因素，但不幸的是并非如此 学习得很好。这可能部分是由于许多 SCD 无人目击，这使得 SCD 触发因素的研究很困难。作为解决这个问题的一个可能的解决方案，我们建议研究心电图 （ECG） 1000 名退伍军人男性双胞胎队列中心脏电不稳定的标志物，这些双胞胎是从 越南时代双胞胎登记处。 Shah 博士是一名早期研究人员，他准备领导这项工作 源于他之前关于急性精神压力引起的心律失常风险的研究 (K23 HL127251)。他的团队 包括 PTSD 和心脏病领域的几位知名研究人员（Viola Vaccarino、Douglas Bremner）、压力和心律失常（Rachel Lampert）以及信号处理/移动健康技术（Gari 克利福德，拉里·贾姆纳）。沙阿博士在过去几年中与这位越南退伍军人密切合作 双胞胎，并且是该队列中经验丰富的调查员。他们生成了重要的初步数据 证明了 PTSD 和 TWA 之间的潜在关系；此外，他们还展示了可行性 在他们目前资助的测量创伤后应激障碍的研究中连续研究退伍军人一周， 自主功能和睡眠。沙阿博士还领导亚特兰大退伍军人事务部的远程医疗工作 医学中心，为当前研究招募和入组提供了重要方法 来自美国各地的远程参与者。第一个目标是评估 PTSD 的关系 使用两种基于心电图的心律失常标志物和心电不稳定：微伏 T 波 交替节律 (TWA) 和形态节拍变异性 (MVB)。预计两者都将与更高的 PTSD 症状，表明心源性猝死的风险急剧增加。关系也是 假设由遗传因素调节：通过评估单合子来调整遗传因素时 双胞胎对 PTSD 不一致，这种关系就会减弱。目标 2 检查之间的关系 通过生态瞬时评估和 MVB/TWA 进行日常 PTSD 症状。我们假设 PTSD 症状和压力的急剧增加也会增加心电不稳定，这是通过更高的测量来衡量的。 环球航空和 MVB。最后，目标 3 尽可能探讨碎片化睡眠和 PTSD 的其他行为相关性 PTSD 可能通过可改变的行为间接影响 SCD 风险。我们的 假设是睡眠碎片化和其他适应不良行为（例如体力活动不足）会导致 每日较高的 TWA/MVB。总体而言，沙阿博士有能力开展这项大型研究。 该项目具有新颖的方法和前所未有的影响力和影响力