{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T19:55:02Z","timestamp":1769975702100,"version":"3.49.0"},"reference-count":39,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2021,4,3]],"date-time":"2021-04-03T00:00:00Z","timestamp":1617408000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["R01HL47337"],"award-info":[{"award-number":["R01HL47337"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Noninvasive Electrocardiol"],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Evidence indicates that emotions such as anger are associated with increased incidence of sudden cardiac death, but the biological mechanisms remain unclear. We tested the hypothesis that, in patients with sudden death vulnerability, anger would be associated with arrhythmic vulnerability, indexed by cardiac repolarization instability.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients with coronary artery disease (CAD) and an implantable cardioverter defibrillator (ICD; <jats:italic>n<\/jats:italic>\u00a0=\u00a041) and healthy controls (<jats:italic>n<\/jats:italic>\u00a0=\u00a026) gave an anger\u2010inducing speech (anger recall), rated their current (state) anger, and completed measures of trait (chronic) levels of Anger and Hostility. Repolarization instability was measured using QT Variability Index (QTVI) at resting baseline and during anger recall using continuous ECG.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>ICD patients had significantly higher QTVI at baseline and during anger recall compared with controls, indicating greater arrhythmic vulnerability overall. QTVI increased from baseline to anger recall to a similar extent in both groups. In ICD patients but not controls, during anger recall, self\u2010rated anger was related to QTVI (<jats:italic>r<\/jats:italic>\u00a0=\u00a0.44, <jats:italic>p<\/jats:italic>\u00a0=\u00a0.007). Trait (chronic) Anger Expression (<jats:italic>r<\/jats:italic>\u00a0=\u00a0.26, <jats:italic>p<\/jats:italic>\u00a0=\u00a0.04), Anger Control (<jats:italic>r<\/jats:italic>\u00a0=\u00a0\u2212.26, <jats:italic>p<\/jats:italic>\u00a0=\u00a0.04), and Hostility (<jats:italic>r<\/jats:italic>\u00a0=\u00a0.25, <jats:italic>p<\/jats:italic>\u00a0=\u00a0.05) were each associated with the change in QTVI from baseline to anger recall (\u0394QTVI). Moderation analyses evaluated whether psychological trait associations with \u0394QTVI were specific to the ICD group. Results indicated that Hostility scores predicted \u0394QTVI from baseline to anger recall in ICD patients (\u03b2\u00a0=\u00a00.07, <jats:italic>p<\/jats:italic>\u00a0=\u00a0.01), but not in controls.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Anger increases repolarization lability, but in patients with CAD and arrhythmic vulnerability, chronic and acute anger interact to trigger cardiac repolarization lability associated with susceptibility to malignant arrhythmias.<\/jats:p><\/jats:sec>","DOI":"10.1111\/anec.12848","type":"journal-article","created":{"date-parts":[[2021,4,4]],"date-time":"2021-04-04T04:28:27Z","timestamp":1617510507000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Psychological factors and cardiac repolarization instability during anger in implantable cardioverter defibrillator patients"],"prefix":"10.1111","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1671-1355","authenticated-orcid":false,"given":"David S.","family":"Krantz","sequence":"first","affiliation":[{"name":"Department of Medical and Clinical Psychology Uniformed Services University of the Health Sciences Bethesda MD USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristie M.","family":"Harris","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Section of Cardiovascular Medicine Yale School of Medicine New Haven CT USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heather L.","family":"Rogers","sequence":"additional","affiliation":[{"name":"Biocruces Bizkaia Health Research Institute Barakaldo Spain"},{"name":"Ikerbasque Basque Foundation for Science Bilbao Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kerry S.","family":"Whittaker","sequence":"additional","affiliation":[{"name":"Research Facilitation Laboratory \u2013 Army Analytics Group Monterey CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6449-4386","authenticated-orcid":false,"given":"Mark C. P.","family":"Haigney","sequence":"additional","affiliation":[{"name":"Division of Cardiology Department of Medicine Military Cardiovascular Outcomes Research (MiCOR) Uniformed Services University of the Health Sciences Bethesda MD USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Willem J.","family":"Kop","sequence":"additional","affiliation":[{"name":"Department of Medical Psychology and Neuropsychology Tilburg University Tilburg The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,4,3]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2004.09.027"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8167.1998.tb00130.x"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.96.5.1557"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.psy.0000145822.15967.15"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrcardio.2016.181"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2008.11.044"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajh\/hpv047"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1037\/h0060667"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2011.03.055"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(95)00510-2"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1542-474X.2008.00274.x"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2004.06.063"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8159.2009.02462.x"},{"key":"e_1_2_9_15_1","volume-title":"Introduction to mediation, moderation, and conditional process analysis: A regression\u2010based approach","author":"Hayes A. 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