From the Department of Medicine, University of Antwerp, Antwerp, Belgium.
Correspondence to Johan Denollet, PhD, Cardiale Revalidatie, University Hospital of Antwerp, Wilrijkstraat, 10, B-2650 Edegem, Belgium.
Background—Patients with myocardial
infarction (MI) with a decreased left ventricular ejection
fraction (LVEF) have a poor prognosis, but the role of emotional stress
in prognosis is not known. We hypothesized that emotional stress in
these patients (1) is unrelated to the severity of cardiac disorder,
(2) predicts cardiac events, and (3) is a function of basic
personality traits.
Methods and Results—Eighty-seven patients with MI (age, 41 to 69
years) with an LVEF of
Conclusions—Personality influences the clinical course of
patients with a decreased LVEF. Emotional distress in these patients is
unrelated to disease severity but reflects individual differences in
personality. Clinical trials should take a broad view of the target of
intervention; assessment of LVEF and personality may identify patients
at risk.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Personality, Disease Severity, and the Risk of Long-term Cardiac Events in Patients With a Decreased Ejection Fraction After Myocardial Infarction
50% underwent psychological assessment at
baseline. Patients and their families were contacted after 6 to 10
years (mean, 7.9 years); cardiac events were defined as cardiac death
or nonfatal MI. Emotional distress was unrelated to the severity of
cardiac disorder. At follow-up, 21 patients had experienced a cardiac
event (13 fatal events). These events were related to LVEF of 30%,
poor exercise tolerance, previous MI, anxiety, anger, and depression
(all P.02). Patients with a distressed personality
(type D; ie, the tendency to suppress negative emotions) were more
likely to experience an event over time compared with non–type D
patients (P=.00005). Cox proportional hazards
analysis yielded LVEF of 30% (relative risk, 3.0; 95%
confidence interval, 1.2 to 7.7; P=.02) and type D
(relative risk, 4.7; 95% confidence interval, 1.9 to 11.8;
P=.001) as independent predictors. Anxiety, anger, and
depression did not add to the predictive power of type D; these
negative emotions were hightly correlated and reflected the personality
domain of negative affectivity.
Key Words: myocardial infarction • mortality • risk factors • prognosis
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