# Association of Posttraumatic Stress Disorder with Cardiac Electrical Instability: A Twin Study

> **NIH NIH R01** · EMORY UNIVERSITY · 2024 · $679,164

## Abstract

ABSTRACT
Psychological stress is a potentially major risk factor for sudden cardiac death (SCD), but unfortunately not
studied very well. This may in part be is due to the fact that many SCDs are unwitnessed, which makes the
study of SCD triggers difficult. As a possible solution to this problem, we propose to study electrocardiographic
(ECG) markers of cardiac electrical instability in a cohort of 1,000 Veteran male twins who are recruited from
the Vietnam Era Twin Registry. Dr. Shah is an Early Stage Investigator who is poised to lead this effort that
follows from his previous work on arrhythmia risk due to acute mental stress (K23 HL127251). His team
includes several established investigators in the field of PTSD and heart disease (Viola Vaccarino, Douglas
Bremner), stress and arrhythmia (Rachel Lampert), and signal processing/mobile health technologies (Gari
Clifford, Larry Jamner). Dr. Shah, over the past several years, has worked closely with the Vietnam veteran
twins and is an experienced investigator with this cohort. They have generated important preliminary data that
demonstrates a potential relationship between PTSD and TWA; in addition, they have demonstrated feasibility
of studying Veterans continuously for one week in their currently funded study which measures PTSD,
autonomic function, and sleep. Dr. Shah is also leading telehealth efforts at the Atlanta Veterans Affairs
Medical Center, which has provided important methodologies for the current study to recruit and enroll
participants from around the United States remotely. The first aim seeks to evaluate the relationship of PTSD
symptoms and cardiac electrical instability using two ECG-based markers for arrhythmia: microvolt T-wave
alternans (TWA) and morphological beat variability (MVB). Both are expected to be associated with higher
PTSD symptoms, suggesting an acutely increased risk of sudden cardiac death. The relationship is also
hypothesized to be moderated by genetic factors: when adjusting for genetic factors by evaluating monozygotic
twin pairs discordant for PTSD, the relationship is attenuated. Aim 2 examines the relationship between
everyday PTSD symptoms with an ecological momentary assessment and MVB/TWA. We hypothesize that
acute increases in PTSD symptoms and stress also increase cardiac electrical instability, measured by higher
TWA and MVB. Finally, aim 3 explores fragmented sleep and other behavioral correlates of PTSD as possible
mechanisms through which PTSD may indirectly impact SCD risk through modifiable behaviors. Our
hypothesis is that sleep fragmentation and other maladaptive behaviors such as low physical activity will result
higher TWA/MVB on a daily basis. Overall, Dr. Shah is a poised and well-equipped to carry out this large
project with novel methods and unprecedented reach in terms of impact and

## Key facts

- **NIH application ID:** 10885992
- **Project number:** 5R01HL155711-04
- **Recipient organization:** EMORY UNIVERSITY
- **Principal Investigator:** Amit Jasvant Shah
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $679,164
- **Award type:** 5
- **Project period:** 2021-07-01 → 2026-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10885992

## Citation

> US National Institutes of Health, RePORTER application 10885992, Association of Posttraumatic Stress Disorder with Cardiac Electrical Instability: A Twin Study (5R01HL155711-04). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10885992. Licensed CC0.

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