Dr. Amit J. Shah, MD- Early Life Trauma Is Associated With Increased Microvolt T‐Wave Alternans During Mental Stres...

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Amit Shah, MD, MSCR is an Assistant Professor of Epidemiology with a part-time appointment in Medicine (Cardiology) at the Atlanta VA Medical Center, where he staffs the outpatient clinic and inpatient consult program. Amit Shah joined the Emery University faculty in 2013, and has received the Atlanta Clinical and Translational Science Institute's KL2 award, as well as funds from the American Heart Association and the National Institutes of Health. He's also a board-certified cardiologist with expertise in echocardiography and nuclear cardiology. In this video Dr. Shah discusses how Early Life Trauma Is Associated With Increased Microvolt T‐Wave Alternans During Mental Stress Challenge.


Early childhood trauma has been linked to an increased risk of cardiovascular disease, but the implications for arrhythmia remain unknown. Early life trauma, we anticipated, predicts greater arrhythmic risk during mental stress in patients with coronary artery disease, as evaluated by elevated microvolt Twave alternans (TWA), a marker of repolarization heterogeneity and sudden cardiac death risk.

Results and Methods
We used the Early Trauma Inventory Self ReportShort Form to look at early life trauma in a group of people with stable coronary artery disease (NCT04123197). Participants performed a structured psychiatric interview as well as a laboratory-based mental stress speaking task with Holter monitoring. TWA was assessed via ambulatory electrocardiographic monitoring during rest, mental stress, and recovery. Multivariable linear regression models were used to account for sociodemographic variables, cardiac history, mental comorbidity, and hemodynamic stress reactivity. We looked at 320 people who had ECGs that were devoid of noise and arrhythmias. The average (SD) age was 63.8 (8.7) years, with 27% of the participants being female and 27% reporting serious childhood trauma (Early Trauma Inventory Self ReportShort Form 10). High childhood trauma was linked to a 17 percent increase in TWA during stress (P=0.04), and each unit increase in the Early Trauma Inventory Self ReportShort Form total score was linked to a 1.7 percent increase in stress TWA (P=0.02). The subtype of emotional trauma had the biggest effect sizes.

Early life trauma, particularly emotional trauma, is linked to higher TWA, a measure of increased arrhythmic risk, during mental stress in a population with stable coronary artery disease. Although more research is needed, this connection shows that early trauma exposures may alter long-term sudden cardiac death risk following emotional triggers.