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  1. Article ; Online: Facial Emotion Expression and the Inducibility of Myocardial Ischemia During Cardiac Stress Testing: The Role of Psychological Background Factors.

    Bekendam, Maria T / Mommersteeg, Paula M C / Vermeltfoort, Ilse A C / Widdershoven, Jos W / Kop, Willem J

    Psychosomatic medicine

    2022  Volume 84, Issue 5, Page(s) 588–596

    Abstract: Objective: Negative emotional states, such as anger and anxiety, are associated with the onset of myocardial infarction and other acute clinical manifestations of ischemic heart disease. The likelihood of experiencing these short-term negative emotions ... ...

    Abstract Objective: Negative emotional states, such as anger and anxiety, are associated with the onset of myocardial infarction and other acute clinical manifestations of ischemic heart disease. The likelihood of experiencing these short-term negative emotions has been associated with long-term psychological background factors such as depression, generalized anxiety, and personality factors. We examined the association of acute emotional states preceding cardiac stress testing (CST) with inducibility of myocardial ischemia and to what extent psychological background factors account for this association.
    Methods: Emotional states were assessed in patients undergoing CST (n = 210; mean [standard deviation] age = 66.9 [8.2] years); 91 (43%) women) using self-report measures and video recordings of facial emotion expression. Video recordings were analyzed for expressed anxiety, anger, sadness, and happiness before CST. Psychological background factors were assessed with validated questionnaires. Single-photon emission computed tomography was used to evaluate inducibility of ischemia.
    Results: Ischemia occurred in 72 patients (34%). Emotional states were not associated with subsequent inducibility of ischemia during CST (odds ratio between 0.93 and 1.04; p values > .50). Psychological background factors were also not associated with ischemia (odds ratio between 0.96 and 1.06 per scale unit; p values > .20) and did not account for the associations of emotional states with ischemia.
    Conclusions: Emotional states immediately before CST and psychological background factors were not associated with the inducibility of ischemia. These findings indicate that the well-documented association between negative emotions with acute clinical manifestations of ischemic heart disease requires a different explanation than a reduced threshold for inducible ischemia.
    MeSH term(s) Aged ; Anger ; Emotions ; Facial Expression ; Female ; Happiness ; Humans ; Male ; Myocardial Ischemia/diagnosis ; Myocardial Ischemia/psychology ; Stress, Psychological/complications
    Language English
    Publishing date 2022-04-14
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 3469-1
    ISSN 1534-7796 ; 0033-3174
    ISSN (online) 1534-7796
    ISSN 0033-3174
    DOI 10.1097/PSY.0000000000001085
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  2. Article ; Online: Facial Expressions of Emotions During Pharmacological and Exercise Stress Testing: the Role of Myocardial Ischemia and Cardiac Symptoms.

    Bekendam, Maria T / Kop, Willem J / Vermeltfoort, Ilse A C / Widdershoven, Jos W / Mommersteeg, Paula M C

    International journal of behavioral medicine

    2021  Volume 28, Issue 6, Page(s) 692–704

    Abstract: Background: Negative emotions have been linked to ischemic heart disease, but existing research typically involves self-report methods and little is known about non-verbal facial emotion expression. The role of ischemia and anginal symptoms in emotion ... ...

    Abstract Background: Negative emotions have been linked to ischemic heart disease, but existing research typically involves self-report methods and little is known about non-verbal facial emotion expression. The role of ischemia and anginal symptoms in emotion expression was examined.
    Methods: Patients undergoing cardiac stress testing (CST) using bicycle exercise or adenosine with myocardial perfusion imaging were included (N = 256, mean age 66.8 ± 8.7 year., 43% women). Video images and emotion expression (sadness, anxiety, anger, and happiness) were analyzed at baseline, initial CST , maximal CST, recovery. Nuclear images were evaluated using SPECT.
    Results: Ischemia (N = 89; 35%) was associated with higher levels of sadness (p = .017, d = 0.34) and lower happiness (p = .015, d = 0.30). During recovery, patients with both ischemia and anginal symptoms had the highest sadness expression (F (3,254) = 3.67, p = .013, eta
    Conclusion: Sadness and reduced happiness were more common in patients with ischemia. Also, anginal symptoms were associated with more negative emotions.
    MeSH term(s) Aged ; Anger ; Emotions ; Facial Expression ; Female ; Happiness ; Humans ; Male ; Middle Aged ; Myocardial Ischemia/diagnosis
    Language English
    Publishing date 2021-02-23
    Publishing country England
    Document type Journal Article
    ZDB-ID 1187972-5
    ISSN 1532-7558 ; 1070-5503
    ISSN (online) 1532-7558
    ISSN 1070-5503
    DOI 10.1007/s12529-021-09963-3
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  3. Article ; Online: Psychological factors of suspect coronary microvascular dysfunction in patients undergoing SPECT imaging.

    Bekendam, Maria T / Vermeltfoort, Ilse A C / Kop, Willem J / Widdershoven, Jos W / Mommersteeg, Paula M C

    Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology

    2020  Volume 29, Issue 2, Page(s) 768–778

    Abstract: Background: Patients with myocardial ischemia in the absence of obstructive coronary artery disease (CAD) often experience anginal complaints and are at risk of cardiac events. Stress-related psychological factors and acute negative emotions might play ... ...

    Abstract Background: Patients with myocardial ischemia in the absence of obstructive coronary artery disease (CAD) often experience anginal complaints and are at risk of cardiac events. Stress-related psychological factors and acute negative emotions might play a role in these patients with suspect coronary microvascular dysfunction (CMD).
    Methods and results: 295 Patients (66.9 ± 8.7 years, 46% women) undergoing myocardial perfusion single-photon-emission computed tomography (MPI-SPECT), were divided as follows: (1) a non-ischemic reference group (n = 136); (2) patients without inducible ischemia, but with a history of CAD (n = 62); (3) ischemia and documented CAD (n = 52); and (4) ischemia and suspect CMD (n = 45). These four groups were compared with regard to psychological factors and acute emotions. Results revealed no differences between the groups in psychological factors (all P > .646, all effect sizes d < .015). State sadness was higher for patients with suspect CMD (16%) versus the other groups (P = .029). The groups did not differ in the association of psychological factors or emotions with anginal complaints (all P values > .448).
    Conclusion: Suspect CMD was not associated with more negative psychological factors compared to other groups. State sadness was significantly higher for patients with suspect CMD, whereas no differences in state anxiety and other psychological factors were found.
    MeSH term(s) Angina Pectoris ; Coronary Angiography ; Coronary Artery Disease ; Female ; Humans ; Ischemia ; Male ; Myocardial Ischemia/complications ; Myocardial Ischemia/diagnostic imaging ; Myocardial Perfusion Imaging ; Tomography, Emission-Computed, Single-Photon
    Language English
    Publishing date 2020-10-06
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1212505-2
    ISSN 1532-6551 ; 1071-3581
    ISSN (online) 1532-6551
    ISSN 1071-3581
    DOI 10.1007/s12350-020-02360-5
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  4. Article ; Online: Anxiety and hemodynamic reactivity during cardiac stress testing: The role of gender and age in myocardial ischemia.

    Bekendam, Maria T / Mommersteeg, Paula M C / Kop, Willem J / Widdershoven, Jos W / Vermeltfoort, Ilse A C

    Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology

    2020  Volume 28, Issue 6, Page(s) 2581–2592

    Abstract: Background: The prevalence of myocardial ischemia is associated with anxiety. State and trait anxiety are more common in younger women compared to men, and high anxiety levels could affect hemodynamic reactivity during cardiac stress testing. The aim is ...

    Abstract Background: The prevalence of myocardial ischemia is associated with anxiety. State and trait anxiety are more common in younger women compared to men, and high anxiety levels could affect hemodynamic reactivity during cardiac stress testing. The aim is to examine whether anxiety plays a role in gender differences in patients ≤ 65 and > 65 years in hemodynamic reactivity and ischemia during cardiac stress testing.
    Methods and results: Included were 291 patients (66.8 ± 8.7 years, 45% women) with suspect ischemia undergoing myocardial perfusion single-photon emission computed tomography (MPI-SPECT). Primary outcomes were semi-quantitative summed difference score (SDS) and summed stress score (SSS), as continuous indicators of myocardial ischemia. Analyses were stratified by age. Trait anxiety was measured using a validated questionnaire (GAD-7) and state anxiety using facial expression analyses software. Overall, trait and state anxiety were not associated with the prevalence of ischemia (N = 107, 36%). A significant interaction was found between gender and trait anxiety in women ≤ 65 years for SDS (F(1,4) = 5.73, P = .019) and SSS (F(1,10) = 6.50, P = .012). This was not found for state anxiety.
    Conclusion: SDS and SSS were significantly higher in women younger than 65 years with high trait anxiety. This interaction was not found in men and women over 65 years.
    MeSH term(s) Age Factors ; Aged ; Anxiety/etiology ; Exercise Test/adverse effects ; Female ; Hemodynamics ; Humans ; Male ; Middle Aged ; Myocardial Ischemia/complications ; Myocardial Ischemia/physiopathology ; Myocardial Ischemia/psychology ; Sex Factors
    Language English
    Publishing date 2020-02-28
    Publishing country United States
    Document type Comparative Study ; Journal Article
    ZDB-ID 1212505-2
    ISSN 1532-6551 ; 1071-3581
    ISSN (online) 1532-6551
    ISSN 1071-3581
    DOI 10.1007/s12350-020-02079-3
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  5. Article ; Online: Ocular findings in 22q11.2 deletion syndrome: A systematic literature review and results of a Dutch multicenter study.

    von Scheibler, Emma N M M / van der Valk Bouman, Emy S / Nuijts, Myrthe A / Bauer, Noël J C / Berendschot, Tos T J M / Vermeltfoort, Pit / Bok, Levinus A / van Eeghen, Agnies M / Houben, Michiel L / van Amelsvoort, Thérèse A M J / Boot, Erik / van Egmond-Ebbeling, Michelle B

    American journal of medical genetics. Part A

    2021  Volume 188, Issue 2, Page(s) 569–578

    Abstract: The 22q11.2 deletion syndrome (22q11.2DS) is a multisystem disorder with an estimated prevalence of 1:3000 live births. Manifestations show a marked variability in expression and include speech- and language delay, intellectual disability, and ... ...

    Abstract The 22q11.2 deletion syndrome (22q11.2DS) is a multisystem disorder with an estimated prevalence of 1:3000 live births. Manifestations show a marked variability in expression and include speech- and language delay, intellectual disability, and neuropsychiatric disorders. We aim to provide an overview of ocular findings in 22q11.2DS in order to optimize recommendations for ophthalmic screening. We combined results from a systematic literature review with results from a multicenter cross-sectional study of patients with 22q11.2DS who were assessed by an ophthalmologist. Our systematic literature search yielded four articles, describing 270 patients. We included 132 patients in our cross-sectional study (median age 8.9 [range 0-56] years). Most reported ocular findings were retinal vascular tortuosity (32%-78%), posterior embryotoxon (22%-50%), eye lid hooding (20%-67%), strabismus (12%-36%), amblyopia (2%-11%), ptosis (4%-6%), and refractive errors, of which hyperopia (6%-48%) and astigmatism (3%-23%) were most common. Visual acuity was (near) normal in most patients (91%-94%). Refractive errors, strabismus, and amblyopia are treatable conditions that are frequently present in patients with 22q11.2DS and should be corrected at an early stage. Therefore, in 22q11.2DS, we recommend ophthalmic and orthoptic screening at the age of 3 years or at diagnosis, and a low-threshold referral in adults.
    MeSH term(s) Adolescent ; Adult ; Child ; Child, Preschool ; Cross-Sectional Studies ; DiGeorge Syndrome/complications ; DiGeorge Syndrome/diagnosis ; DiGeorge Syndrome/epidemiology ; Eye Abnormalities/diagnosis ; Humans ; Infant ; Infant, Newborn ; Intellectual Disability ; Language ; Middle Aged ; Multicenter Studies as Topic ; Young Adult
    Language English
    Publishing date 2021-11-12
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Systematic Review
    ZDB-ID 2108614-X
    ISSN 1552-4833 ; 0148-7299 ; 1552-4825
    ISSN (online) 1552-4833
    ISSN 0148-7299 ; 1552-4825
    DOI 10.1002/ajmg.a.62556
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  6. Article ; Online: Long-term prognosis of patients with cardiac syndrome X: a review.

    Vermeltfoort, I A C / Teule, G J J / van Dijk, A B / Muntinga, H J / Raijmakers, P G H M

    Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation

    2012  Volume 20, Issue 9, Page(s) 365–371

    Abstract: Aims: Follow-up studies of patients with cardiac syndrome X (CSX) generally report good prognosis. However, some recent studies report an adverse outcome for women.: Methods and results: Structured literature search and meta-analysis for studies ... ...

    Abstract Aims: Follow-up studies of patients with cardiac syndrome X (CSX) generally report good prognosis. However, some recent studies report an adverse outcome for women.
    Methods and results: Structured literature search and meta-analysis for studies regarding prognosis of cardiac syndrome X patients. We identified 85 studies, ultimately selecting 16 for inclusion. Meta-analysis yielded a pooled major cardiac event percentage of 1.5% per 5 years and a pooled vascular event percentage of 4.8% per 5 years (n = 16 studies, n = 1694 patients). Fourteen studies reported upon the recurrence rate of angina pectoris: the pooled percentage of angina recurrence was 55% (n = 1336 patients).
    Conclusion: The present review of recent archival literature demonstrates an overall major cardiac event rate of 1.5% per 5 years. Although this is an excellent prognosis for CSX patients, the quality of life is impaired because of the high recurrence rate of angina pectoris (55%).
    Language English
    Publishing date 2012-02-22
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 2211468-3
    ISSN 1876-6250 ; 1568-5888 ; 0929-7456
    ISSN (online) 1876-6250
    ISSN 1568-5888 ; 0929-7456
    DOI 10.1007/s12471-012-0256-z
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  7. Article: Improved myocardial perfusion preceding clinical response on bosentan treatment for coronary vasospasm.

    Vermeltfoort, Ilse A C / Raijmakers, Pieter G H M / Kamphuisen, Pieter W

    Acta cardiologica

    2009  Volume 64, Issue 3, Page(s) 415–417

    Abstract: Many patients suffer from persistent angina due to coronary vasospasm despite optimal medical treatment. We treated a 46-year-old patient with severe and treatment-resistant coronary vasospasm with the endothelin-receptor antagonist bosentan. Using ... ...

    Abstract Many patients suffer from persistent angina due to coronary vasospasm despite optimal medical treatment. We treated a 46-year-old patient with severe and treatment-resistant coronary vasospasm with the endothelin-receptor antagonist bosentan. Using oxygen-15-labelled water in conjunction with oxygen 15-labelled carbon monoxide positron emission tomography (PET), we measured an impaired coronary flow reserve (CFR) in 6 out of 13 segments directly before the start of bosentan therapy. A repeated PET measurement after 16 weeks of bosentan revealed a completely normalized CFR in this patient. Furthermore, the patient reported less frequent and less severe chest pain. Our data suggest a potential role of endothelin-receptor antagonists for patients with severe coronary vasospasms.
    MeSH term(s) Angina Pectoris, Variant/diagnosis ; Angina Pectoris, Variant/drug therapy ; Angina Pectoris, Variant/physiopathology ; Antihypertensive Agents/therapeutic use ; Blood Flow Velocity ; Coronary Vasospasm/diagnosis ; Coronary Vasospasm/drug therapy ; Coronary Vasospasm/physiopathology ; Fractional Flow Reserve, Myocardial ; Humans ; Male ; Middle Aged ; Myocardial Perfusion Imaging ; Positron-Emission Tomography ; Sulfonamides/therapeutic use
    Chemical Substances Antihypertensive Agents ; Sulfonamides ; bosentan (Q326023R30)
    Language English
    Publishing date 2009-06
    Publishing country England
    Document type Case Reports ; Journal Article
    ZDB-ID 390197-x
    ISSN 0001-5385
    ISSN 0001-5385
    DOI 10.2143/AC.64.3.2038032
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  8. Article ; Online: Definitions and incidence of cardiac syndrome X: review and analysis of clinical data.

    Vermeltfoort, I A C / Raijmakers, P G H M / Riphagen, I I / Odekerken, D A M / Kuijper, A F M / Zwijnenburg, A / Teule, G J J

    Clinical research in cardiology : official journal of the German Cardiac Society

    2010  Volume 99, Issue 8, Page(s) 475–481

    Abstract: There is no consensus regarding the definition of cardiac syndrome X (CSX). We systematically reviewed recent literature using a standardized search strategy. We included 57 articles. A total of 47 studies mentioned a male/female distribution. A meta- ... ...

    Abstract There is no consensus regarding the definition of cardiac syndrome X (CSX). We systematically reviewed recent literature using a standardized search strategy. We included 57 articles. A total of 47 studies mentioned a male/female distribution. A meta-analysis yielded a pooled proportion of females of 0.56 (n = 1,934 patients, with 95% confidence interval: 0.54-0.59). As much as 9 inclusion criteria and 43 exclusion criteria were found in the 57 articles. Applying these criteria to a population with normal coronary angiograms and treated in 1 year at a general hospital, the attributable CSX incidence varied between 3 and 11%. The many inclusion and exclusion criteria result in a wide range of definitions of CSX and these have large effects on the incidence. This shows the need for a generally accepted definition of CSX.
    MeSH term(s) Female ; Humans ; Incidence ; Male ; Microvascular Angina/classification ; Microvascular Angina/epidemiology ; Terminology as Topic
    Language English
    Publishing date 2010-04-21
    Publishing country Germany
    Document type Journal Article ; Meta-Analysis ; Review
    ZDB-ID 2213295-8
    ISSN 1861-0692 ; 1861-0684
    ISSN (online) 1861-0692
    ISSN 1861-0684
    DOI 10.1007/s00392-010-0159-1
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  9. Article: Definitions and incidence of cardiac syndrome X: review and analysis of clinical data

    Vermeltfoort, I. A. C / Raijmakers, P. G. H. M / Riphagen, I. I / Odekerken, D. A. M / Kuijper, A. F. M / Zwijnenburg, A / Teule, G. J. J

    Clinical research in cardiology official journal of the German Cardiac Society. 2010 Aug., v. 99, no. 8

    2010  

    Abstract: There is no consensus regarding the definition of cardiac syndrome X (CSX). We systematically reviewed recent literature using a standardized search strategy. We included 57 articles. A total of 47 studies mentioned a male/female distribution. A meta- ... ...

    Abstract There is no consensus regarding the definition of cardiac syndrome X (CSX). We systematically reviewed recent literature using a standardized search strategy. We included 57 articles. A total of 47 studies mentioned a male/female distribution. A meta-analysis yielded a pooled proportion of females of 0.56 (n = 1,934 patients, with 95% confidence interval: 0.54-0.59). As much as 9 inclusion criteria and 43 exclusion criteria were found in the 57 articles. Applying these criteria to a population with normal coronary angiograms and treated in 1 year at a general hospital, the attributable CSX incidence varied between 3 and 11%. The many inclusion and exclusion criteria result in a wide range of definitions of CSX and these have large effects on the incidence. This shows the need for a generally accepted definition of CSX.
    Language English
    Dates of publication 2010-08
    Size p. 475-481.
    Publisher Springer-Verlag
    Publishing place Berlin/Heidelberg
    Document type Article
    ZDB-ID 2213295-8
    ISSN 1861-0692 ; 1861-0684
    ISSN (online) 1861-0692
    ISSN 1861-0684
    DOI 10.1007/s00392-010-0159-1
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  10. Article ; Online: Association between anxiety disorder and the extent of ischemia observed in cardiac syndrome X.

    Vermeltfoort, I A C / Raijmakers, P G H M / Odekerken, D A M / Kuijper, A F M / Zwijnenburg, A / Teule, G J J

    Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology

    2009  Volume 16, Issue 3, Page(s) 405–410

    Abstract: Background: A possible link between the heart and brain has been reported for cardiac syndrome X. Anxiety disorder could be a pathophysiological mechanism for this cardiac chest pain. To the authors' knowledge, a quantitative analysis correlating ... ...

    Abstract Background: A possible link between the heart and brain has been reported for cardiac syndrome X. Anxiety disorder could be a pathophysiological mechanism for this cardiac chest pain. To the authors' knowledge, a quantitative analysis correlating anxiety with the extent of ischemia has not been done.
    Methods and results: In this pilot study, we evaluated 20 patients with typical chest pain and completely normal coronary angiograms. These patients were screened with the State Scale and Trait Scale of the State-Trait Anxiety Inventory (STAI). All patients underwent myocardial perfusion scintigraphic imaging. The scintigrams were scored by three experienced readers having no knowledge of the STAI screening results. Patients with a low trait anxiety had significantly less ischemic segments on the myocardial perfusion imaging than patients with a high trait anxiety (1.8 +/- 1.9 vs 3.5 +/- 0.6, P < .05). For state anxiety, no significant differences could be found.
    Conclusion: Cardiac syndrome X patients with high trait anxiety are at risk of having more ischemia.
    MeSH term(s) Anxiety/complications ; Anxiety/diagnostic imaging ; Chest Pain ; Female ; Humans ; Male ; Microvascular Angina/complications ; Microvascular Angina/diagnostic imaging ; Middle Aged ; Myocardial Ischemia/complications ; Myocardial Ischemia/diagnostic imaging ; Pilot Projects ; Reproducibility of Results ; Sensitivity and Specificity ; Tomography, Emission-Computed, Single-Photon/methods
    Language English
    Publishing date 2009-01-22
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1212505-2
    ISSN 1532-6551 ; 1071-3581
    ISSN (online) 1532-6551
    ISSN 1071-3581
    DOI 10.1007/s12350-008-9032-2
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