title: Positive and Negative Affect Is Related to Experiencing Chest Pain During Exercise-Induced Myocardial Ischemia.
abstract: OBJECTIVE
  Silent myocardial ischemia is thought to be associated with worse cardiovascular outcomes due to a lack of perception of pain cues that initiate treatment seeking. Negative affect (NA) has been associated with increased pain reporting and positive affect (PA) with decreased pain reporting, but these psychological factors have not been examined within the context of myocardial ischemia. This study evaluated the associations between PA, NA, and chest pain reporting in patients with and without ischemia during exercise testing.
  
  
  METHODS
  A total of 246 patients referred for myocardial perfusion single-photon emission computed tomography exercise stress testing completed the positive and negative affect schedule-expanded version, a measure of PA and NA. Presence of chest pain and myocardial ischemia were evaluated using standardized protocols.
  
  
  RESULTS
  Logistic regression analyses revealed that for every 1-point increase in NA, there was a 13% higher chance for ischemic patients (odds ratio [OR] = 1.13; 95% confidence interval [CI] = 1.02 to 1.26) and an 11% higher chance in nonischemic patients (OR = 1.11; 95% CI = 1.03 to 1.19) to report chest pain. A significant interaction of PA and NA on chest pain reporting (β = 0.02; 95% CI = 0.002 to 0.031) was also observed; nonischemic patients with high NA and PA reported more chest pain (57%) versus patients with low NA and low PA (13%), with high NA and low PA (17%), and with high PA and low NA (7%).
  
  
  CONCLUSIONS
  Patients who experience higher NA are more likely to report experiencing chest pain. In patients without ischemia, high NA and PA was also associated with a higher likelihood of reporting chest pain. Results suggest that high levels of PA as well as NA may increase the experience and/or reporting of chest pain.
authors.affiliation: From the Department of Psychology (Stébenne, Lavoie), University of Québec at Montréal; Research Centre (Stébenne, Bacon, Arsenault, Meloche, Dupuis, Lavoie), Montreal Heart Institute, Montréal, Québec, Canada; Montreal Behavioural Medicine Centre, Research Centre (Stébenne, Bacon, Austin, Paine, Laurin, Gordon, Lavoie), Hôpital du Sacré-Coeur - CIUSSS-NIM; Department of Exercise Science (Bacon, Austin, Paine), Concordia University, Montréal, Québec, Canada; Department of Social and Behavioral Sciences (Austin), University of Arkansas at Pine Bluff, Arkansas; and Department of Psychology (Gordon), University of Regina, Regina, Saskatoon, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Stébenne
authors.forename: Simon L
authors.initials: SL
authors.lastname: Bacon
authors.forename: Anthony
authors.initials: A
authors.lastname: Austin
authors.forename: Nicola J
authors.initials: NJ
authors.lastname: Paine
authors.forename: André
authors.initials: A
authors.lastname: Arsenault
authors.forename: Catherine
authors.initials: C
authors.lastname: Laurin
authors.forename: Bernard
authors.initials: B
authors.lastname: Meloche
authors.forename: Jennifer
authors.initials: J
authors.lastname: Gordon
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Dupuis
authors.forename: Kim L
authors.initials: KL
authors.lastname: Lavoie
mesh_terms: D000328:Adult; D000339:Affect / Q000502:physiology; D000368:Aged; D000369:Aged, 80 and over; D002637:Chest Pain / Q000000981:diagnostic imaging / Q000209:etiology* / Q000523:psychology; D015444:Exercise / Q000502:physiology* / Q000523:psychology; D005080:Exercise Test / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000209:etiology* / Q000523:psychology; D010147:Pain Measurement; D015899:Tomography, Emission-Computed, Single-Photon