Depression and anxiety are prevalent and associated with a worse prognosis in coronary heart disease (CHD) patients. However, the influence of disease severity on mood symptoms is unknown. The specific associations of mood symptoms with NYHA classes remain unexplored. In this cross-sectional study, 443 consecutive inpatients with angina pectoris (AP) confirmed by angiography were included into analysis. Somatic and cognitive symptom scores derived from Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder Scale (GAD-7) were used to assess mood symptoms. Predictors for depression and anxiety with strict and lax standards were compared. We hypothesized NYHA classification to be an indicator of disease severity through analyses with clinical features using ordinal logistic model. Applying both binary and ordinal logistic models, we evaluated the associations of mood symptoms with NYHA classes. Discrepancy of disease severity existed between the depressed and nondepressed. NYHA classification was proved to be an integrated index under influence of age, coronary stenosis, heart failure and diabetes. NYHA class I and II individuals with AP were at equivalent risk for depression (NYHA II vs I: binary model OR 1.32 (0.59,2.96), p = 0.50; ordinal model OR 1.17 (0.73,1.88), p = 0.52), however NYHA class III/IV patients shared a sharply higher risk (NYHA III/IV vs I: binary model OR 3.32 (1.28,8.61), p = .013; ordinal model OR 3.94 (2.11,7.36), p < .001). Analyses on somatic and cognitive depressive symptoms confirmed this finding and hinted a greater impact of education background on mood when patient’s condition is unstable. Anxiety seemed in the whole picture irrelevant with NYHA classes. Comparing with NYHA class I/II, AP patients in NYHA class III/IV tended to be less anxious. However, when CHD became unstable, the calmness may immediately be broken up. A great distinction of the ratio of anxiety and depression symptom scores between NYHA class III/IV stable and unstable AP patients (p = .018) was observed. Mood symptoms in CHD patients are to a great extend derived from disease itself. Only for patients with relatively serious physical condition, unexpected discomforts caused by disease notably impact the emotions. Education background tends to influence the mood especially when disease is still unstable.

Background: Angina with no obstructive coronary disease (ANOCA) and ischemia with no obstructive coronary disease, prevalent yet underrecognized conditions, mostly affect women. Previous studies rarely distinguished between them. We aimed to compare the prevalence of objective ischemia through various examinations in women with ANOCA and assess the impact of objective and subjective ischemia on their mental health. Methods and Results: A total of 84 eligible women with ANOCA and 42 controls underwent mental stress, pharmacological stress, exercise stress, and Holter testing. Objective evidence of myocardial ischemia was assessed by positron emission tomography‐computed tomography and ECG, and subjective symptoms were graded using the Canadian Cardiovascular Society scale (CCS). Psychological assessments were conducted using 6 scales. Among 84 women with ANOCA, 37 (44%) received a diagnosis of ischemia with no obstructive coronary disease following mental stress testing, 20 (28.6%) through pharmacological stress testing, 14 (21.2%) via exercise stress testing, and 24 (32.9%) from Holter. Mental stress‐induced myocardial ischemia was more prevalent ( P <0.05). Among 54 patients with ANOCA who completed all tests, 30% showed no ischemia, and only 1 (1.9%) showed ischemia in all tests. In addition, patients with ANOCA had higher psychological scores than controls ( P 0.05). However, ANOCA with milder angina (CCS I) exhibited higher scores across the Hospital Anxiety and Depression Scale, State‐Trait Anxiety Inventory, Perceived Stress Scale, and Posttraumatic Stress Disorder Checklist‐Civilian Version and a higher prevalence of Type D personality traits ( P <0.05). Conclusions: In patients with ANOCA, the positive rate of myocardial ischemia exhibits variability among several noninvasive tests. A worsened psychological state is more closely linked to milder angina symptoms than to ischemia performance, highlighting the importance of focusing on symptom management in their psychological care. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03982901.

Background: Mental stress-induced myocardial ischemia (MSIMI) is common in women with angina with no obstructive coronary artery disease (ANOCA) and is associated with adverse cardiovascular outcomes. Interleukin-6 (IL-6), a central mediator of chronic inflammation, predicts future cardiovascular risk, but its relationship with MSIMI remains unclear. Methods: Eighty women with ANOCA underwent ¹³ N-ammonia positron emission tomography/computed tomography to assess myocardial perfusion and myocardial blood flow (MBF) at rest, during mental stress, and during adenosine-induced stress. Resting inflammatory biomarkers were measured, and multivariable logistic and linear regression models were used to evaluate associations with mental stress-induced perfusion defects. Proteomic profiling was performed in a selected subset to explore potential underlying mechanisms. Results: Mental stress induced significantly greater myocardial perfusion defects in MSIMI+ patients. Resting IL-6 levels were significantly higher in MSIMI+ patients (3.20 versus 1.80 pg/mL, p = 0.024). Although baseline CRP, hsCRP, and complement C3 levels were also higher in MSIMI+ patients, only resting IL-6 remained independently associated with both the presence of MSIMI and the severity of mental stress-induced myocardial perfusion defects after adjustment for demographic, clinical, and psychosocial factors, and resting MBF. Proteomic analyses demonstrated enrichment of innate immune–hemostatic pathways and mitochondrial oxidative phosphorylation in MSIMI+ patients with high IL-6 levels. Conclusions: Elevated resting IL-6 is independently associated with the presence and severity of MSIMI in women with ANOCA. These findings suggest that IL-6 may serve as a biomarker of MSIMI and support IL-6-related inflammation as a key pathophysiological pathway underlying MSIMI, with potential implications for targeted therapeutic strategies.

Background Prior studies examining depression and anxiety among individuals with coronary artery disease (CAD) have predominantly concentrated on their connection with clinical and laboratory markers, disregarding the profound effect of the cardinal symptom—chest pain. The potential influence of chest pain on the prognostic significance of depression and anxiety, encompassing cardiovascular outcomes, has yet to be fully investigated. Methods Secondary analyses based on a cross-sectional research for investigating prevalence of mood symptoms/disorder in CAD patients. Five-hundred and sixty-one consecutive inpatients were enrolled. The prognostic data was consistently monitored over a median follow-up period of 26 months. The aims of this study were to determine the influence of chest pain on depression and anxiety symptoms and their prognostic effects in CAD. Logistic regression models were used for selecting the most relevant predictors for mood symptoms. Cox regression model were applied for analyzing the prognostic values. Results The prevalence of having depression and anxiety symptoms in CAD reached 37.6% and 27.3%, respectively. Comprehensive analyses revealed that the primary correlated factors for depression were chest pain frequency, age, history of diabetes, and exercise time, and for anxiety were chest pain frequency, chest pain course, and education level. As the common and strongest predictor, chest pain frequency demonstrated a dose-dependent relationship with the risk for mood symptoms. Chest pain frequency and course were not directly associated with prognosis, however impact the prognostic effect of mood symptoms. The association between major adverse cardiovascular events (MACEs) and depression symptoms was primarily observed in patients with a high chest pain frequency, whereas with anxiety was mainly presented in patients with a short chest pain course. For noncardiac rehospitalization, anxiety presented higher predictive value in participants with low chest pain frequencies, while depression was right the opposite. Conclusions These findings underscore the significance of considering chest pain as a crucial factor when investigating the influence of mood symptoms in CAD patients. Particularly, individuals with mood symptoms who experience frequent chest pain episodes despite a short course warrant special attention. Enhancing their emotional well-being and addressing chest pain symptoms might potentially yield valuable clinical benefits.