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Impedance cardiography (ICG), especially when measured during stress, can help understand the underlying psychophysiological pathways linking PTSD with heart failure. We investigated the association between PTSD and ICG\u2010based contractility metrics (pre\u2010ejection period (PEP) and Heather index (HI)) using a controlled twin study design with a laboratory\u2010based traumatic reminder stressor. PTSD status was assessed using structured clinical interviews. We acquired synchronized electrocardiograms and ICG data while playing personalized\u2010trauma scripts. Using linear mixed\u2010effects models, we examined twins as individuals and within PTSD\u2010discordant pairs. We studied 137 male veterans (48 pairs, 41 unpaired singles) from Vietnam War Era with a mean (standard deviation) age of 68.5(2.5) years. HI during trauma stress was lower in the PTSD vs. non\u2010PTSD individuals (7.2 vs. 9.3 [ohm\/s<jats:sup>2<\/jats:sup>], <jats:italic>p<\/jats:italic>\u00a0=\u2009.003). PEP reactivity (trauma minus neutral) was also more negative in PTSD vs. non\u2010PTSD individuals (\u22127.4 vs. \u22122.0 [ms], <jats:italic>p<\/jats:italic>\u00a0=\u2009.009). The HI and PEP associations with PTSD persisted for adjusted models during trauma and reactivity, respectively. For within\u2010pair analysis of eight PTSD\u2010discordant twin pairs (out of 48 pairs), PTSD was associated with lower HI in neutral, trauma, and reactivity, whereas no association was found between PTSD and PEP. PTSD was associated with reduced HI and PEP, especially with trauma recall stress. This combination of increased sympathetic activation and decreased cardiac contractility combined may be concerning for increased heart failure risk after recurrent trauma re\u2010experiencing in PTSD.<\/jats:p>","DOI":"10.1111\/psyp.14197","type":"journal-article","created":{"date-parts":[[2022,10,26]],"date-time":"2022-10-26T07:49:01Z","timestamp":1666770541000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Association between <scp>PTSD<\/scp> and Impedance Cardiogram\u2010based contractility metrics during trauma recall: A controlled twin study"],"prefix":"10.1111","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2503-7187","authenticated-orcid":false,"given":"Shafa\u2010at Ali","family":"Sheikh","sequence":"first","affiliation":[{"name":"Department of Biomedical Informatics Emory University  Georgia Atlanta USA"},{"name":"School of Electrical and Computer Engineering Georgia Institute of Technology  Georgia Atlanta USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4269-0965","authenticated-orcid":false,"given":"Erick A.","family":"Perez Alday","sequence":"additional","affiliation":[{"name":"Department of Biomedical Informatics Emory University  Georgia Atlanta USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali Bahrami","family":"Rad","sequence":"additional","affiliation":[{"name":"Department of Biomedical Informatics Emory University  Georgia Atlanta USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oleksiy","family":"Levantsevych","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Rollins School of Public Health Emory University  Georgia Atlanta USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mhmtjamil","family":"Alkhalaf","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Rollins School of Public Health Emory University  Georgia Atlanta USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Majd","family":"Soudan","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Rollins School of Public Health Emory University  Georgia Atlanta USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rami","family":"Abdulbaki","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Rollins School of Public Health Emory University  Georgia Atlanta USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ammer","family":"Haffar","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Rollins School of Public Health Emory University  Georgia Atlanta USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas L.","family":"Smith","sequence":"additional","affiliation":[{"name":"Veterans Affairs Health Care System  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jack","family":"Goldberg","sequence":"additional","affiliation":[{"name":"Veterans Affairs Health Care System  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Douglas","family":"Bremner","sequence":"additional","affiliation":[{"name":"Veterans Affairs Health Care System  Decatur Georgia USA"},{"name":"Department of Psychiatry Emory University School of Medicine  Georgia Atlanta USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viola","family":"Vaccarino","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Rollins School of Public Health Emory University  Georgia Atlanta USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omer T.","family":"Inan","sequence":"additional","affiliation":[{"name":"School of Electrical and Computer Engineering Georgia Institute of Technology  Georgia Atlanta USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gari D.","family":"Clifford","sequence":"additional","affiliation":[{"name":"Department of Biomedical Informatics Emory University  Georgia Atlanta USA"},{"name":"Department of Biomedical Engineering Georgia Institute of Technology and Emory University  Georgia Atlanta USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9099-9687","authenticated-orcid":false,"given":"Amit J.","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Rollins School of Public Health Emory University  Georgia Atlanta USA"},{"name":"Veterans Affairs Health Care System  Decatur Georgia USA"},{"name":"Department of Medicine, Division of Cardiology Emory University School of Medicine  Georgia Atlanta USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,10,26]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/psyp.12799"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-08-030145-7.50009-X"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1037\/a0033432"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1017\/CBO9780511546396.008"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyi153"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2018.01.024"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/(sici)1097\u20100258(19971030)16:20<2349::aid\u2010sim667>3.0.co;2\u2010e"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0165\u20101781(00)00195\u20105"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2019.112684"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/psyp.13724"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/PSY0000000000000326"},{"key":"e_1_2_9_13_1","first-page":"134","volume-title":"Comprehensive handbook of psychological assessment. 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