Anxiety is associated with increased risk for atrial cardiopathy
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ORIGINAL ARTICLE
Anxiety is associated with increased risk for atrial cardiopathy Zhaolu Wang1 · Huiyuan Qin2 · Guilin Chen3 · Yan Dai4 · Yingyuan Cai5 · Xi Cheng5 · Yun Qian5 · Ming Chu2 · Xiaowei Lu5 Received: 1 January 2020 / Accepted: 10 March 2020 © Belgian Neurological Society 2020
Abstract Anxiety is common in patients with atrial fibrillation (AF). The mutual causal effect between anxiety and AF is expected with limited evidence. Atrial cardiopathy is a term to describe structural or electrophysiological atrium abnormality that precedes the onset of AF. This study aimed to investigate the association of anxiety with atrial cardiopathy, giving a clue to the causal relationship of this mind–heart link. This cross-sectional study analyzed 532 patients who were free of AF, atrial flutter, stroke, acute coronary syndrome and valvular heart disease. Atrial cardiopathy was defined as P-wave terminal force in lead V1 > 5000 μV·ms on electrocardiogram or severe left atrial enlargement on echocardiogram. Generalized anxiety disorder was ascertained by a score of > 17/56 on Hamilton anxiety rating scale. Multivariable logistic regression was used to explore the association of anxiety with atrial cardiopathy. A total of 65(12.2%) patients had atrial cardiopathy and 53(10.0%) had generalized anxiety disorder, respectively. Those with atrial cardiopathy were older (74.0 vs 67.0, P 140 mmHg and/or diastolic blood pressure > 90 mmHg, a history of hypertension or use of antihypertensive medication. Diabetes mellitus (DM) was defined as fasting serum glucose ≥ 7.0 mmol/L, postprandial serum glucose ≥ 11.1 mmol/L, or use of hypoglycemic agents or insulin. Hyperlipidemia was defined as total cholesterol level of ≥ 5.2 mmol/L, low-density lipoprotein cholesterol level of ≥ 2.6 mmol/L, triglyceride level of ≥ 1.70 mmol/L, or the use of lipid lowering drugs. In addition, the concentrations of serum K+, Na+, Cl−, and Ca2+ were also measured. PTFV1 was measured using digital calipers on standard digital 12-lead ECGs, measuring the absolute value of the depth (μv) time of the duration (ms) of the downward deflection (terminal portion) of the p-wave in lead 1 [9]. Premature complexes were recorded on ECGs. Left atrial diameter (LAD) measurement was performed during end ventricular systole on echocardiography. Left ventricular
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Acta Neurologica Belgica
ejection fraction (LVEF), left ventricular posterior wall thickness (LVPWT), and the early-diastolic left ventricular inflow velocity (E) were measured on echocardiography. The peak early-diastolic velocity (e’) of the lateral and the septal mitral annulus were measured and averaged to calculate E/e′, reflecting diastolic dysfunction. Atrial cardiopathy was defined as PTFV1 > 5000 μV ms or severe left atrial enlargement (LAE) [9, 10]. These data were rated by a cardiologist blinded to the clinical information of participants. HAM-A (14 symptom-defined elements) was used to evaluate anxiety symptoms. The clinically widely used HAM-A is comprised of both psychological and soma
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