Association of stress-induced autonomic dysfunction with heart failure in individuals with stable coronary artery disease
Background: Heart failure (HF) is a common complication in individuals with coronary artery disease (CAD). Autonomic effects of psychological stress may play an important, under-recognized role in this relationship. We hypothesized that stress-induced autonomic dysfunction, measured by change in low...
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| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-08-01
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| Series: | International Journal of Cardiology: Heart & Vasculature |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352906725000971 |
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| Summary: | Background: Heart failure (HF) is a common complication in individuals with coronary artery disease (CAD). Autonomic effects of psychological stress may play an important, under-recognized role in this relationship. We hypothesized that stress-induced autonomic dysfunction, measured by change in low-frequency heart rate variability (HRV) during mental stress challenge, associates with increased HF risk. Methods: We examined 662 participants with stable CAD and no known diagnosis of HF who underwent mental stress challenge via a standardized speaking task in conjunction with Holter monitoring. We evaluated HRV in 5-minute windows and examined its change from rest to stress as our primary exposure. Repeated events Cox proportional hazard models were used to examine incident and recurrent acute HF in the outpatient and inpatient setting. Results: The mean age was 58 years, 35 % were women, and 43 % self-identified as Black. In models adjusted for age, sex, race, comorbidities, ejection fraction, and resting low-frequency HRV, each standard deviation decrease (negative change) in low-frequency HRV change from rest to stress was associated with an increased risk of incident and recurrent acute HF (HR 1.39 [95 % CI 1.02–1.90], p = 0.035) over a median follow-up of 5.7 years. These estimates for HF risk were higher than those of resting HRV. Conclusion: Greater decreases in low-frequency HRV change during acute mental stress challenge independently associate with higher risks of future HF development in individuals with stable CAD and had stronger effect sizes than resting HRV alone, highlighting an important role of stress autonomic pathways in the pathogenesis of HF. |
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| ISSN: | 2352-9067 |