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| Name | Class |
|---|---|
| The Elisabeth-TweeSteden Hospital | OTHER |
| Elisabeth-TweeSteden Ziekenhuis | OTHER |
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Psychosocial factors have been found to be associated with an increased risk for coronary artery disease incidence, progression and worse clinical outcomes.
Patients with non-significant coronary artery disease (confirmed vascular irregularities, but <60% coronary occlusion) often present with complaints such as chest pain, which warrant screening by coronary angiography (CAG) or computed tomography (CT scan). The prognosis of this group of patients with mild stenosis remains to be investigated in more detail, and we propose that psychosocial factors play a role in the clinical prognosis and patient reported outcomes in this group.
A special focus lies within examining personality characteristics, of which Type D personality is a primary predictor variable for prognosis. Type D personality is characterised by high negative affect and high social inhibition. In addition to psychosocial factors (personality, mood state, social support, SES), biomarkers(inflammation, clotting, DNA) as well as standard clinical risk factors (metabolic syndrome, activity level, smoking, medication use, disease severity) will be investigated.
The goal of the proposed study is to investigate a preexisting psycho-biochemical risk profile for major adverse cardiovascular events (MACE) and patient perceived symptoms in a group with angiographically or CT-scan confirmed, non-significant coronary artery disease.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| CAG and CT group | CAG group = patients included based on coronary angiography screening; CT group = patients included based on computed tomography screening |
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| Measure | Description | Time Frame |
|---|---|---|
| Major Adverse Cardiac Events (MACE) | MACE includes the occurence of a recurrent coronary angiography, emergency hospitalization (for cardiac reasons), myocardial infarction, percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG), mortality (cardiac/noncardiac) | Average 42 months (Range 12-72; at least 12 months after inclusion final participant) |
| Patient Perceived Health Status | patient perceived health status includes self-reported chest pain, disease specific health status, generic health status, fatigue and mood (depression/anxiety). Double time point was included for this outcome measure to examine changes over time, compared to baseline. | 12 and 24 months |
| Measure | Description | Time Frame |
|---|---|---|
| Psychosocial factors | The secondary aim is to investigate the correlation and the stability over time between psychosocial factors, biochemical variables, traditional cardiac risk factors and measures of outcome. Psychosocial factors include questionnaires as personality scales (Type D personality, Cook-Medley Hostility scale 27 item version), depression (HADS-D at each time point, BDI, CESD-10 and PHQ9 at consecutive time points), anxiety (HADS-A at each time point), fatigue (FAS), global mood scale (Positive and negative affect), generic health status (Short Form 12), specific health status (Seattle Angina Questionnaire). Indicators of education level, marital status, lifestyle factors, and activity level. |
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Inclusion Criteria:
Exclusion Criteria:
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All patients who have received coronary angiography or computed tomography at the TweeSteden Hospital Tilburg are being screened since January 2009.
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| Name | Affiliation | Role |
|---|---|---|
| Paula M.C. Mommersteeg, PhD | Tilburg University | Principal Investigator |
| Jos W. Widdershoven, MD PhD | The Elisabeth-TweeSteden Hospital | Principal Investigator |
| Wilbert Aarnoudse, MD PhD | The Elisabeth-TweeSteden Hospital | Study Chair |
| Johan Denollet, PhD | Tilburg University | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| TweeSteden Hospital Tilburg | Tilburg | Dr. Deelenlaan 5 | 5042 AD | Netherlands |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 23263915 | Result | Mommersteeg PM, Pot I, Aarnoudse W, Denollet J, Widdershoven JW. Type D personality and patient-perceived health in nonsignificant coronary artery disease: the TWeesteden mIld STenosis (TWIST) study. Qual Life Res. 2013 Oct;22(8):2041-50. doi: 10.1007/s11136-012-0340-2. Epub 2012 Dec 21. | |
| 25307791 | Result | Mommersteeg PM, Meeuwis SH, Denollet J, Widdershoven JW, Aarnoudse W, Westerhuis BL, Kop WJ. C-reactive protein and fibrinogen in non-obstructive coronary artery disease as related to depressive symptoms and anxiety: findings from the TweeSteden Mild Stenosis Study (TWIST). J Psychosom Res. 2014 Nov;77(5):426-9. doi: 10.1016/j.jpsychores.2014.09.020. Epub 2014 Oct 2. |
| Label | URL |
|---|---|
| CoRPS: Center of Research on Psychology in Somatic diseases. Primary funding for the TWIST study. | View source |
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| Type | Date | Date Unknown |
|---|---|---|
| Release | Mar 15, 2022 | |
| Unrelease | Mar 16, 2022 | |
| Release | Mar 16, 2022 | |
| Reset | Jul 1, 2022 | |
| Release | Aug 28, 2025 | |
| Reset | Sep 17, 2025 | |
| Release | Oct 1, 2025 | |
| Reset | Oct 21, 2025 |
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| Release Date | Unrelease Date | Unrelease Date Unknown | Reset Date | MCP Release Number |
|---|---|---|---|---|
| Mar 15, 2022 | Mar 16, 2022 | |||
| Mar 16, 2022 |
| ID | Term |
|---|---|
| D003324 | Coronary Artery Disease |
| D050197 | Atherosclerosis |
| D023921 | Coronary Stenosis |
| D002318 | Cardiovascular Diseases |
| D003863 | Depression |
| D001008 | Anxiety Disorders |
| D005221 | Fatigue |
| D002637 | Chest Pain |
| D024821 | Metabolic Syndrome |
| D009765 | Obesity |
| D012907 | Smoking |
| D000428 | Alcohol Drinking |
| D009043 | Motor Activity |
| D006973 | Hypertension |
| D003920 | Diabetes Mellitus |
| ID | Term |
|---|---|
| D003327 | Coronary Disease |
| D017202 | Myocardial Ischemia |
| D006331 | Heart Diseases |
| D001161 | Arteriosclerosis |
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Serum, DNA, leukocyte differentiation, high-sensitive C-reactive protein, fibrinogen
| baseline, 12 and 24 months |
| Biochemical correlates | Examine biochemical correlates in relation to psychosocial and traditional cardiac risk factors. Standard assessment is done for high sensitive C-reactive protein (hsCRP), fibrinogen, leukocyte count and differentiation, and registration of lipid profile, glucose, creatinin at baseline. Baseline and 12 month serum samples are collected and stored at -80, as well as DNA samples for future funding opportunities. | baseline, 12 and 24 months |
| 26105088 | Result | Mommersteeg PM, Widdershoven JW, Aarnoudse W, Denollet J. Personality subtypes and chest pain in patients with nonobstructive coronary artery disease from the TweeSteden Mild Stenosis study: mediating effect of anxiety and depression. Eur J Pain. 2016 Mar;20(3):427-37. doi: 10.1002/ejp.743. Epub 2015 Jun 24. |
| 31421324 | Derived | Mommersteeg PMC, Naude PJW, Bagijn W, Widdershoven J, Westerhuis BWJJM, Schoemaker RG. Gender differences in associations of depressive symptoms and anxiety with inflammatory markers in patients with non-obstructive coronary artery disease. J Psychosom Res. 2019 Oct;125:109779. doi: 10.1016/j.jpsychores.2019.109779. Epub 2019 Jul 17. |
| 28228453 | Derived | Mommersteeg PM, Arts L, Zijlstra W, Widdershoven JW, Aarnoudse W, Denollet J. Impaired Health Status, Psychological Distress, and Personality in Women and Men With Nonobstructive Coronary Artery Disease: Sex and Gender Differences: The TWIST (Tweesteden Mild Stenosis) Study. Circ Cardiovasc Qual Outcomes. 2017 Feb;10(2):e003387. doi: 10.1161/CIRCOUTCOMES.116.003387. Epub 2017 Feb 22. |
| TweeSteden Hospital, Tilburg, the Netherlands. Study location and CoRPS collaboration \[Site in Dutch\] | View source |
| Jul 1, 2022 |
| Aug 28, 2025 | Sep 17, 2025 |
| Oct 1, 2025 | Oct 21, 2025 |
| D001157 |
| Arterial Occlusive Diseases |
| D014652 | Vascular Diseases |
| D001526 | Behavioral Symptoms |
| D001519 | Behavior |
| D001523 | Mental Disorders |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D007333 | Insulin Resistance |
| D006946 | Hyperinsulinism |
| D044882 | Glucose Metabolism Disorders |
| D008659 | Metabolic Diseases |
| D009750 | Nutritional and Metabolic Diseases |
| D050177 | Overweight |
| D044343 | Overnutrition |
| D009748 | Nutrition Disorders |
| D001835 | Body Weight |
| D004327 | Drinking Behavior |
| D004700 | Endocrine System Diseases |