Research has shown that the expression of negative emotions in response to a real or perceived provocation seems to consistently correlate with acute cardiac events. A biomedical model incorporating simultaneous Heart-Brain endpoints with behavior which is manifested and shaped by latent cultural and social determinants is our challenge.
The published work of our group has shown that there are pathophysiologic distinctions in cerebral and cardiovascular determinants of Mental Stress Ischemia compared to ischemia which results from exercise and that these patients have a poor prognosis. Work of others have confirmed our initial reports regarding prognosis and independent reports that there is a survival advantage when rehabilitation strategies are tailored accordingly. Given that it has been shown that up to 75% of CAD subjects are vulnerable to myocardial ischemia in response to mental stressors this is a leading public health issue and merits the attention of serious scientific inquiry. Given the novelty and difficulty of these experimental designs which employ simultaneous biomedical measurements of heart and brain performance or electrophysiologic instability while inducing ischemia-- the risks for failure were high. However with each success we found that very few could replicate the comprehensive approach to this difficult problem. Thus, our institution has led the way in reporting fundamental observations related to the pathophysiologic antecedents and consequences of this clinical presentation.
Neurobehavioral faculty members have been involved following clinical trials:
- The NHLBI funded ENRICHD randomized clinical trial, which sought to determine the effect on medical prognosis of treating depression and low social support in immediate post-MI patients.
- The two NHLBI funded Projects (COPES and CODIACS) that successfully tested a patient preference, stepped-care approach to depression treatment for persistently depressed post-ACS patients.
- An ongoing randomized clinical trial of stress management treatment for new recipients of ICD and for ICD patients who have recently experienced a shock terminated ventricular arrhythmia that has, along with laboratory based indices, incidence of shock treated ventricular arrhythmias as its endpoint.
- An RCT investigation of ambulatory T-wave alternans in relation to daytime episodes of moderate emotional arousal, with a particular focus on anger.