2017 Resarch Forum

PSY: M-3

Applicant: Naser Ahmadi MD PhD Principal Investigator: Mohammed Molla MD

Preserved Coronary Distensibility Index is Associated with Reduced Adulthood Posttraumatic Stress Disorder in Youth with Adverse Childhood Experience Naser Ahmadi MD PhD 1,2,3 , Fereshteh Hajsadeghi MD 1 ,Garth Olango MD PhD 1 , Mohammed Molla MD 1 1 Kern Medical 2 Greater Los Angeles VA 3 Los Angeles Biomedical Research Institute INTRODUCTION: Impaired coronary distensibility index (CDI) is a marker of vascular dysfunction, measures an endothelial dependent process, and is associated with vulnerable plaque composition, and predicts major adverse cardiovascular event (MACE). We previously reported that impaired CDI is strongly associated with the severity of adverse childhood experiences’ (ACE) symptoms and predicts an increased risk of MACE in subjects with ACE. PURPOSE: This study investigated the relation of ACE and adulthood posttraumatic stress disorder (PTSD) in youth with and without preserved CDI. METHOD: Two hundred forty-six subjects (age range: 18-70 years, 31%women) with (n=79) and without (n=167) ACE who underwent Computed tomography angiography (CTA) for clinical indication and their CDI was measured. ACE was measured using Childhood Trauma Questionnaire (CTQ), and Dimensions of Stressful Events Rating Scale (DOSE). CDI in left anterior descending artery (LAD) was defined as: [(Early diastole mid diastole lumen cross section area (CSA))/(lumen CSA in mid diastole x central pulse pressure)x1000]. Preserved CDI defined as CDI>2.4. PTSD was measured using Clinician Administered PTSD Scale and PTSD Checklist– Military scores, and verified by medical records. Mixed regression analyses were employed to assess the relation of ACE with and without preserved CDI with adulthood PTSD. RESULTS: A significant inverse correlation between CDI and Clinical Global Impression scale (CGI) of ACE symptoms was noted (r 2 =0.61, p=0.001). CDI was significantly lower in subjects with ACE, compared to those without ACE (3.1±0.2 vs.4.6±0.2, p=0.001). Regression analyses revealed that ACE is independently associated with adulthood PTSD (likelihood ratio: 18.9, 95% CI 8.5- 42.2, p=0.001). The likelihood of adulthood PTSD in ACE without preserved CDI was 10.6 (95% CI 5.4- 25.6, p=0.001) folds higher, compared to ACE with preserved CDI. The likelihood of adulthood PTSD was less in ACE with preserved CDI, compared to ACE without preserved CDI (6% vs. 45%, p=0.001), which was comparable to those without ACE (3.5%)(P>0.05). DISCUSSION: The findings of this study reveals strong association between preserved coronary vascular function, and reduced incidence of PTSD in subjects with MACE. CONCLUSIONS: Preserved CDI is strongly associated with the reduced adulthood PTSD in subjects with ACE. This highlights the important role of early intervention and preserving CDI in identifying individuals with ACE at risk for MACE.