Related Experiment Video
Updated: May 12, 2026
A Randomized, Sham-Controlled Trial of Cranial Electrical Stimulation for Fibromyalgia Pain and Physical Function, Using Brain Imaging Biomarkers
Published on: January 5, 2024
A genotype-specific, randomized controlled behavioral intervention to improve the neuroemotional outcome of cardiac
Daniela Hauer1, Iris-Tatjana Kolassa, Rüdiger Paul Laubender
1Department of Anaesthesiology, Ludwig-Maximilians University, Munich 81377, Germany. daniela.hauer@med.uni-muenchen.de
Insights
A targeted cognitive behavioral intervention can reduce traumatic memories and PTSD symptoms after heart surgery in patients with a specific genetic risk factor (Bcll GG genotype). This improves the neuroemotional outcome for these individuals.
Area of Science:
- Cardiology
- Genetics
- Psychiatry
Background:
- Cardiac surgery is a common procedure with significant physical and emotional stress.
- Up to 20% of patients develop stress-related disorders like PTSD post-surgery.
- A specific gene polymorphism (Bcll) in the glucocorticoid receptor gene is linked to increased risk of traumatic memories and PTSD after cardiac surgery.
Purpose of the Study:
- To investigate the efficacy of a preoperative cognitive behavioral intervention in reducing traumatic memories and PTSD symptoms.
- To determine if this intervention can normalize neuroemotional outcomes in high-risk patients (Bcll GG genotype).
Main Methods:
- A randomized controlled trial involving 872 patients undergoing cardiac surgery.
- Patients genotyped for the Bcll single nucleotide polymorphism.
- High-risk Bcll GG carriers and low-risk individuals randomized to cognitive behavioral intervention or a control group.
- Primary endpoint: post-traumatic stress levels at one year post-surgery.
Main Results:
- The study aims to demonstrate that the intervention reduces traumatic memories and PTSD symptoms in Bcll GG carriers.
- The goal is to achieve symptom levels comparable to non-carriers of the high-risk allele.
- This intervention is expected to improve the overall neuroemotional outcome after cardiac surgery.
Conclusions:
- Preoperative cognitive behavioral intervention is a promising strategy for mitigating psychological distress after cardiac surgery.
- Targeting interventions based on genetic risk factors (Bcll polymorphism) can personalize patient care.
- This approach has the potential to significantly improve the quality of life for patients undergoing cardiac surgery.
Background:
Cardiac surgery is one of the most commonly performed surgical procedures worldwide with >700,000 surgeries in 2006 in the US alone. Cardiac surgery results in a considerable exposure to physical and emotional stress; stress-related disorders such as depression or post-traumatic stress disorder are the most common adverse outcomes of cardiac surgery, seen in up to 20% of patients. Using information from a genome-wide association study to characterize genetic effects on emotional memory, we recently identified a single nucleotide polymorphism of the glucocorticoid receptor gene (the Bcll single nucleotide polymorphism) as a significant genetic risk factor for traumatic memories from cardiac surgery and symptoms of post-traumaticstress disorder. The Bcll high-risk genotype (Bcll GG) has a prevalence of 16.6% in patients undergoing cardiac surgery and is associated with increased glucocorticoid receptor signaling under stress. Concomitant animal experiments have confirmed an essential role of glucocorticoid receptor activation for traumatic memory formation during stressful experiences. Early cognitive behavioral intervention has been shown to prevent stress-related disorders after heart surgery.
Methods/Design:
The proposed study protocol is based on the above mentioned earlier findings from animal experiments and preclinical studies in volunteers. Patients (n = 872) will be genotyped for the Bcll single nucleotide polymorphism before surgery, which should result in 120 homozygous high-risk carriers of the Bcll GG allele and 240 randomly selected low-risk heterozygous or non-carriers of the single nucleotide polymorphism. All patients will then undergo randomization to either cognitive behavioral intervention or a control intervention consisting of non-specific general information about the role of stress in heart disease. The primary efficacy endpoint will be post-traumatic stress levels at one year after surgery as determined by a standardized questionnaire that has been specifically validated in patients after critical illness.
Discussion:
The proposed randomized controlled trial intends to demonstrate that a preoperatively administered minimal cognitive behavioral intervention targeted to homozygous carriers of the Bcll *G high-risk allele reduces traumatic memories and post-traumatic stress disorder symptoms after heart surgery to a level seen in non-carriers of the mutation, and thus improves the neuroemotional outcome of cardiac surgery.
Trial Registration Number:
The trial will be registered at http://www.clinicaltrials.gov/ before commencing with the study.