Psycho-emotional manifestations of valvular heart diseases: prospective assessment in mitral regurgitation.
OBJECTIVE
To define the prevalence and consequences of post-traumatic stress disorder (PTSD) as an emotional response to cardiac diseases in patients with mitral regurgitation.


METHODS
We prospectively enrolled 186 patients with moderate or severe organic mitral regurgitation, presenting class I (absent) or II (minimal) dyspnea, who were compared with 80 controls of similar age (38 with completely normal cardiac function; 42 with mild mitral-valve prolapse; all with no, or at most mild, mitral regurgitation). Mitral-regurgitation severity and consequences were comprehensively measured, simultaneously with PTSD, anxiety, and depression.


RESULTS
PTSD prevalence was higher in mitral-regurgitation patients vs controls (23% vs 9%, P <.01). Although mitral-regurgitation objective severity (regurgitant volume 77.8 ± 28.9 vs 79.0 ± 27.5 mL, P = .8) and objective consequences (left-atrial volume 59.1 ± 20.9 vs 54.02 ± 15.6 mL, P = .1; right-ventricular systolic pressure 34.1 ± 11.4 vs 32.9 ± 7.2 mm Hg, P = .6) were similar with and without PTSD (all P ≥.1), patients with PTSD were more symptomatic (class II 74 vs 38%; fatigue 71% vs 38%, both P <.0001) and had higher anxiety and depressions scores (P <.0001).


CONCLUSIONS
PTSD is prevalent in organic moderate or severe mitral-regurgitation patients but is not determined by objective mitral-regurgitation severity or consequences. PTSD is linked to anxiety and depression and to symptoms usually considered cardiac, such as dyspnea. Thus, PTSD and psycho-emotional manifestations, linked to symptoms, represent important responses to chronic-valve disease that may affect clinical outcomes.
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn; JDC-Meyers-Brookdale Institution, Jerusalem, Israel.
Tali
T
Bayer-Topilsky
Max R
MR
Trenerry
Rakesh
R
Suri
Yan
Y
Topilsky
Ryan M
RM
Antiel
Yariv
Y
Marmor
Douglas W
DW
Mahoney
Hartzell V
HV
Schaff
Maurice
M
Enriquez-Sarano
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001007:Anxiety / Q000453:epidemiology / Q000209:etiology*; D016022:Case-Control Studies; D003863:Depression / Q000453:epidemiology / Q000209:etiology*; D004417:Dyspnea / Q000209:etiology* / Q000523:psychology; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000503:physiopathology / Q000523:psychology*; D015995:Prevalence; D011446:Prospective Studies; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D011795:Surveys and Questionnaires
Chronic mitral regurgitation; PTSD; Symptoms