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: 10438848
• 负责人: Amit Jasvant Shah
• 金额: $ 69.32万
• 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/10438848
• 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; Enrollment; 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; Outcome Study; Participant; Physical activity; Pilot Projects; Play; 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; Role; 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; adjudicate; base; 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; physical inactivity; poor sleep; prospective; psychological trauma; recruit; sedentary lifestyle; signal processing; sleep behavior; stress related disorder; 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 心理压力是心脏猝死（SCD）的潜在主要危险因素，但不幸的是 学习得很好。这可能部分是由于许多SCD不愿意的事实，这使得 SCD触发的研究困难。作为解决此问题的可能解决方案，我们建议研究心电图 （ECG）从1,000名老将男双胞胎组成的心脏电不稳定性标记 越南时代双注册表。 Shah博士是一名早期舞台调查员，他准备领导这项努力 从他先前关于急性精神压力引起的心律失常风险的工作（K23 HL127251）。他的团队 包括几位在PTSD和心脏病领域的既定研究者（Viola Vaccarino，Douglas Bremner），压力和心律不齐（Rachel Lampert）和信号处理/移动健康技术（GARI 克利福德（Larry Jamner））。 Shah博士在过去的几年中与越南退伍军人紧密合作 双胞胎是该队列的经验丰富的调查员。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，它们已经证明了可行性 在目前资助的研究中，不断研究退伍军人一周，该研究测量PTSD， 自主功能和睡眠。 Shah博士还在亚特兰大退伍军人事务中领导远程医疗努力 医疗中心为当前研究提供了重要的方法来招募和注册 来自美国各地的参与者遥不可及。第一个目的旨在评估PTSD的关系 症状和心脏电不稳定性，使用两个基于ECG的心律失常标记：微伏T波 替代品（TWA）和形态节拍变异性（MVB）。两者都预计将与更高 PTSD症状，表明心脏猝死的风险急剧增加。关系也是 假设由遗传因素调节：通过评估单卵形来调整遗传因素 双胞胎对与PTSD不一致，关系减弱。 AIM 2检查 日常生态瞬时评估和MVB/TWA的PTSD症状。我们假设这一点 PTSD症状和压力的急性增加也会增加心脏电不稳定，通过较高的 TWA和MVB。最后，AIM 3尽可能探索零散的睡眠和其他行为相关性 PTSD通过可修改行为间接影响SCD风险的机制。我们的 假设是睡眠破碎和其他适应不良行为（例如身体活动少）会导致 每天更高的TWA/MVB。总的来说，沙阿博士是一个准备好且能够实现这一庞大的能力 从影响和影响方面，具有新颖方法和前所未有的覆盖范围的项目