Relationship between echocardiographic indicators, coronary artery lesions, and anxiety in patients with coronary heart disease

Abstract

BACKGROUND

Patients with coronary heart disease (CHD) frequently experience anxiety due to symptoms such as chest pain and tightness. However, it remains unclear whether changes in echocardiographic findings, a routine component of CHD evaluation, are associated with anxiety levels in these patients.

AIM

To investigate the relationship between echocardiographic indicators, coronary artery lesions, and anxiety in patients with CHD.

METHODS

Data from 110 patients with stable CHD were retrospectively collected. Based on coronary angiography findings and Gensini scores used to assess the severity of coronary artery lesions, patients were classified into mild (38 cases), moderate (42 cases), and severe (30 cases) groups. Anxiety levels were assessed using the Self-Rating Anxiety Scale (SAS) at admission, and patients were categorized into no anxiety (16 cases), mild anxiety (31 cases), moderate anxiety (41 cases), and severe anxiety (22 cases) groups. The Cochran-Armitage trend test, Pearson correlation analysis, and multiple linear regression analysis were applied to examine the relationships among echocardiographic indicators, coronary artery disease severity, and anxiety in patients with CHD.

RESULTS

Trend analysis revealed significant linear relationships between the severity of coronary artery lesions, anxiety levels, and echocardiographic parameters in patients with CHD. As the severity of coronary artery lesions and anxiety increased, left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic volume (LVESV), and left ventricular end-diastolic volume (LVEDV) showed an upward trend (P < 0.05), whereas left ventricular ejection fraction (LVEF) exhibited a downward trend (P < 0.05). Pearson correlation analysis revealed that the Gensini score was positively correlated with LVEDD, LVESV, and LVEDV (r = 0.352, r = 0.386, and r = 0.376, respectively; P < 0.05) and negatively correlated with LVEF (r = -0.442; P < 0.05). Similarly, the SAS score was positively correlated with LVEDD, LVESV, and LVEDV (r = 0.279, r = 0.248, r = 0.216, respectively; P < 0.05) and negatively correlated with LVEF (r = -0.218; P < 0.05). Multiple regression analysis showed that, after adjusting for confounding factors, both higher Gensini and SAS scores remained independent risk factors for increased LVEDD, LVESV, and LVEDV and for decreased LVEF in patients with CHD (P < 0.05).

CONCLUSION

Echocardiographic indicators are significantly correlated with both coronary artery lesions and anxiety in patients with CHD. In clinical practice, anxiety assessment and management should be integrated into comprehensive CHD treatment to more effectively improve cardiac function, alleviate symptoms, and improve overall prognosis.

Key Words: Echocardiography; Coronary heart disease; Coronary artery lesion; Anxiety; Correlation

Core Tip: Patients with coronary heart disease often experience pronounced anxiety due to symptoms such as chest tightness and pain. This study demonstrated that echocardiographic indicators are correlated not only with the severity of coronary artery disease but also with patients’ anxiety levels. Integrating anxiety assessment into coronary heart disease management may help improve cardiac function and alleviate symptoms more effectively.

INTRODUCTION

Coronary heart disease (CHD) is primarily caused by coronary artery stenosis or occlusion resulting from atherosclerosis[1]. Coronary angiography (CAG) is considered the gold standard for diagnosing CHD, as it involves injecting a contrast agent into the coronary arteries to visualize stenosis in the main vessels and their branches. However, it is an invasive diagnosis with high examination costs and cannot evaluate the cardiac function. In addition, some patients may be allergic or intolerant to contrast agents, which further limits their clinical applicability. Echocardiography, based on the principle of ultrasound ranging, enables cross-sectional imaging of the heart and major blood vessels to evaluate cardiac structure and function. It is noninvasive, convenient, and suitable for bedside use, making it the preferred imaging modality for patients with CHD in clinical practice[2]. However, a patient’s psychological state may influence the accuracy or effectiveness of echocardiographic evaluation. Numerous studies have shown that patients with CHD frequently experience anxiety[3,4]. Anxiety is a complex psychological and physiological response involving cognitive, emotional, behavioral, and physiological components. Studies have shown that the severity and extent of coronary artery stenosis are closely associated with anxiety[5]. However, the relationship between echocardiographic parameters, coronary artery lesions, and anxiety levels in patients with CHD remains unclear. Therefore, this study analyzed clinical data from 110 patients with CHD to examine these relationships and provide insights for managing anxiety, improving cardiac function, and alleviating symptoms in this patient population.

MATERIALS AND METHODS

Research object

Clinical data from 110 patients with stable CHD were retrospectively collected from the Department of Cardiology, Suzhou Ninth People’s Hospital, between May 2024 and May 2025. According to the CAG findings and Gensini scores at admission, patients were classified into mild (38 cases), moderate (42 cases), and severe (30 cases) coronary artery lesion groups. Based on the Self-Rating Anxiety Scale (SAS) results obtained at admission, patients were further categorized into non-anxiety (16 cases), mild anxiety (31 cases), moderate anxiety (41 cases), and severe anxiety (22 cases) groups. Inclusion criteria were as follows: (1) Met the diagnostic criteria outlined in the “Guidelines for the Diagnosis and Treatment of Stable Coronary Artery Disease”[6] and confirmed by CAG examination; (2) Age ≥ 18 years, with complete clinical data; (3) New York Heart Association (NYHA)[7] cardiac function classification ≤ grade II at admission; and (4) Complete echocardiographic and anxiety assessment results available at admission. Exclusion criteria were as follows: (1) Presence of severe valvular disease or congenital heart disease; (2) Presence of malignant tumors; (3) Presence of pericardial effusion; (4) History of cardiac surgery; (5) Severe liver or kidney dysfunction; (6) Presence of stenosis in the common carotid artery; and (7) Prior treatment with medications such as beta-blockers or antidepressants before admission.

Research methods

Baseline data: Patient’s electronic medical records were reviewed to collect baseline information, including age, gender, smoking history, alcohol consumption, history of myocardial infarction, and NYHA classification at admission.

Ultrasound examination: Echocardiogram reports obtained at patient admission were reviewed to collect echocardiographic parameters. Cardiac ultrasound examinations were performed using the GE Vivid E95 and Philips iU22 diagnostic systems, both equipped with an M5Sc phased-array probe (1.4-4.6 Megahertz). Patients were positioned in the left lateral decubitus position with the anterior chest exposed, and the probe was placed at the third to fifth intercostal spaces on the left side. The following parameters were measured: Left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic volume (LVESV), and left ventricular end-diastolic volume (LVEDV). The left ventricular ejection fraction (LVEF) was calculated accordingly. All measurements were performed by experienced ultrasound physicians in strict accordance with the Chinese Adult Echocardiography Measurement Guidelines[8].

Coronary artery lesions: CAG reports obtained at patient admission were reviewed to obtain information on coronary artery lesions. CAG was performed using the standard Judkins technique through the radial or femoral artery. Each vessel was imaged in at least three projections to evaluate the degree of stenosis in the epicardial coronary arteries and their main branches. The severity of coronary artery lesions was evaluated based on the examination results and the Gensini scoring system[9]. For each lesion, the score was calculated by multiplying the severity score of the stenosis by the weighting factor corresponding to the location of the lesion. The total Gensini score was obtained by summing all lesion scores, with higher scores indicating more severe coronary artery disease. Based on the total Gensini score, lesion severity was classified as mild (< 20 points), moderate (20-50 points), or severe (> 50 points). The specific scoring criteria are presented in Table 1.

Table 1 Gensini score of coronary artery.

Narrowness degree	Rating (points)	Location of lesion	Rating (points)
Complete occlusion	32	Small coronary artery branches	0.5
91%-99%	16	Left anterior descending distal segment	1.0
76%-90%	8	Right Coronary Artery	1.0
51%-75%	4	Middle or distal segment of the left circumflex branch	1.0
26%-50%	2	Middle segment of the left anterior descending branch	1.5
1%-25%	1	Left anterior descending branch or proximal circumflex branch	2.5
-		Left main	5

Anxiety assessment: Anxiety levels were obtained by reviewing the anxiety questionnaire completed by each patient at admission. The SAS[10] was used to assess anxiety levels in patients with CHD. The SAS includes 20 items, of which 15 are positively worded and 5 are negatively worded. Each item is rated on a 4-point Likert scale (1-4 points). The total score is calculated by summing all item scores, and the standard score is derived by multiplying the total score by 1.25 and rounding to the nearest whole number. Higher scores indicate greater anxiety severity. Scores below 50 indicate no anxiety, scores ranging from 50 to 59 indicate mild anxiety, scores between 60 and 69 indicate moderate anxiety, and scores of 70 or above indicate severe anxiety.

Statistical analysis

Data were analyzed using SPSS version 27.0. Categorical variables were expressed by the number of cases and the composition ratio [n (%)], and group comparisons were performed using the χ² test. Continuous variables were expressed as mean ± SD, and differences among multiple groups were tested using one-way analysis of variance (F-test). The Cochran-Armitage test was applied to analyze trends in echocardiographic indicators across varying degrees of coronary artery disease and anxiety levels. Pearson correlation analysis was conducted to examine the relationships among the Gensini score, SAS score, and echocardiographic parameters. Multiple linear regression analysis was used to evaluate the effects of the Gensini and SAS scores on echocardiographic indicators in patients with CHD. A P value < 0.05 was considered statistically significant.

RESULTS

Comparison of baseline data

There were no significant differences in age, gender, smoking history, alcohol consumption history, history of myocardial infarction, or NYHA classification among the mild, moderate, and severe coronary artery lesion groups (P > 0.05; Table 2). Similarly, no significant differences were observed in these variables among the non-anxious, mild anxiety, moderate anxiety, and severe anxiety (P > 0.05) groups (Table 3).

Table 2 Comparison of baseline data in different coronary artery disease groups.

Baseline information	Mild group (n = 38)	Moderate group (n = 42)	Severe group (n = 30)	F/χ2 value	P value
Age (years)	56.12 ± 10.64	57.43 ± 11.61	57.62 ± 11.94	0.188	0.829
Gender				0.089	0.957
Male	25 (65.79)	28 (66.67)	19 (63.33)
Female	13 (34.21)	14 (33.33)	11 (36.67)
With a history of smoking	18 (47.37)	16 (38.10)	14 (46.67)	0.852	0.653
With a history of drinking	17 (44.74)	19 (45.24)	17 (56.67)	1.191	0.551
History of myocardial infarction	3 (7.89)	6 (14.29)	7 (23.33)	3.218	0.201
NYHA classification				5.341	0.069
≤ Grade I	33 (86.84)	33 (78.57)	19 (63.33)
GradeⅡ	5 (13.16)	9 (21.43)	11 (36.67)

Table 3 Comparison of baseline data of different anxiety groups.

Baseline information	No-anxious group (n = 16)	Mild anxiety group (n = 31)	Moderate anxiety group (n = 41)	Severe anxiety group (n = 22)	F/χ2 value	P value
Age (years)	57.02 ± 9.64	57.42 ± 10.61	57.50 ± 11.84	55.61 ± 9.24	0.169	0.917
Gender					0.817	0.845
Male	10 (62.50)	19 (61.29)	27 (65.85)	16 (72.73)
Female	6 (37.50)	12 (38.71)	14 (34.15)	6 (27.27)
With a history of smoking	7 (43.75)	14 (45.16)	20 (48.78)	7 (31.82)	1.720	0.633
With a history of drinking	8 (50.00)	16 (51.61)	19 (46.34)	10 (45.45)	0.289	0.962
History of myocardial infarction	0 (0.00)	4 (12.90)	7 (17.07)	5 (22.73)	4.186	0.242
NYHA classification					3.497	0.321
≤ Grade I	14 (87.50)	25 (80.65)	32 (78.05)	14 (63.64)
GradeⅡ	2 (12.50)	6 (19.35)	9 (21.95)	8 (36.36)

NYHA: New York Heart Association.

Comparison of echocardiographic indexes among coronary artery disease groups

Significant differences were observed in LVEDD, LVESV, LVEDV, and LVEF levels among patients with varying degrees of coronary artery disease (P < 0.05; Table 4). The Cochran-Armitage trend test revealed a linear relationship between the severity of coronary artery lesions and echocardiographic parameters. As the severity of coronary artery lesions increased, LVEDD, LVESV, and LVEDV values increased (Z = 2.432, Z = 2.785, and Z = 3.905, respectively; P < 0.05), whereas LVEF decreased (Z = -2.869; P < 0.05). The trends of these changes are illustrated in Figure 1A.

Figure 1 Trends in echocardiographic parameters in patients. A: Trends in echocardiographic parameters in patients with different coronary artery disease severity; B: Trends in echocardiographic parameters in patients with different anxiety severity levels. LVEDD: Left ventricular end-diastolic diameter; LVEDV: Left ventricular end-diastolic volume; LVESV: Left ventricular end-systolic volume; LVEF: Left ventricular ejection fraction.

Table 4 Comparison of echocardiographic indexes in different coronary artery disease groups.

Group	n	LVEDD (mm)	LVESV (mL)	LVEDV (mL)	LVEF (%)
Mild group	38	49.32 ± 3.51	45.25 ± 2.98	118.67 ± 5.09	56.18 ± 4.27
Moderate group	42	57.19 ± 3.48	55.27 ± 3.24	131.51 ± 6.93	47.42 ± 3.53
Severe group	30	60.54 ± 3.73	69.69 ± 3.93	157.84 ± 6.72	40.73 ± 2.19
F value		92.011	444.601	331.202	165.603
P value		< 0.001	< 0.001	< 0.001	< 0.001

LVEDD: Left ventricular end-diastolic diameter; LVEDV: Left ventricular end-diastolic volume; LVESV: Left ventricular end-systolic volume; LVEF: Left ventricular ejection fraction.

Comparison of echocardiographic indicators across anxiety groups

Significant differences were observed in LVEDD, LVESV, LVEDV, and LVEF levels among patients with different anxiety levels (P < 0.05; Table 5). The Cochran-Armitage trend test revealed a linear relationship between anxiety severity and echocardiographic parameters. As anxiety severity increased, LVEDD, LVESV, and LVEDV values increased (Z = 2.396, Z = 2.795, and Z = 3.898, respectively; P < 0.05), while LVEF decreased (Z = -2.853; P < 0.05). The trends of these changes are illustrated in Figure 1B.

Table 5 Comparison of echocardiographic indicators in different anxiety groups.

Group	n	LVEDD (mm)	LVESV (mL)	LVEDV (mL)	LVEF (%)
No-anxious group	16	47.87 ± 2.82	44.19 ± 2.52	117.84 ± 4.85	58.76 ± 6.24
Mild anxiety group	31	51.43 ± 3.21	49.87 ± 3.38	125.36 ± 6.42	50.38 ± 5.75
Moderate anxiety group	41	57.21 ± 3.48	56.48 ± 3.52	135.23 ± 7.03	46.41 ± 4.82
Severe anxiety group	22	63.02 ± 3.81	71.04 ± 3.93	156.91 ± 6.92	42.89 ± 1.94
F value		81.470	235.201	139.801	36.420
P value		< 0.001	< 0.001	< 0.001	< 0.001

LVEDD: Left ventricular end-diastolic diameter; LVEDV: Left ventricular end-diastolic volume; LVESV: Left ventricular end-systolic volume; LVEF: Left ventricular ejection fraction.

Correlation between coronary artery lesions and echocardiographic indicators in patients with CHD

The Gensini score of coronary artery lesions in patients with CHD was positively correlated with LVEDD, LVESV, and LVEDV (r = 0.352, r = 0.386, and r = 0.376, respectively; all P < 0.05) and negatively correlated with LVEF (r = -0.442; P < 0.05; Figure 2).

Figure 2 Correlation analysis of coronary artery lesions in patients with coronary heart disease and echocardiographic indicators. A: Correlation analysis of Gensini score and left ventricular end-diastolic diameter; B: Correlation analysis of Gensini score and left ventricular end-systolic volume; C: Correlation analysis of Gensini score and left ventricular end-diastolic volume; D: Correlation analysis of Gensini score and left ventricular ejection fraction. LVEDD: Left ventricular end-diastolic diameter; LVEDV: Left ventricular end-diastolic volume; LVESV: Left ventricular end-systolic volume; LVEF: Left ventricular ejection fraction.

Correlation between anxiety levels and echocardiographic indicators in patients with CHD

The SAS score was positively correlated with LVEDD, LVESV, and LVEDV (r = 0.279, r = 0.248, and r = 0.216, respectively; all P < 0.05) and negatively correlated with LVEF (r = -0.218; P < 0.05; Figure 3).

Figure 3 Correlation analysis of anxiety levels in patients with coronary heart disease and echocardiographic indicators. A: Correlation analysis of Self-Rating Anxiety Scale (SAS) score and left ventricular end-diastolic diameter; B: Correlation analysis of SAS score and left ventricular end-systolic volume; C: Correlation analysis of SAS score and left ventricular end-diastolic volume; D: Correlation analysis of SAS score and left ventricular ejection fraction. LVEDD: Left ventricular end-diastolic diameter; LVEDV: Left ventricular end-diastolic volume; LVESV: Left ventricular end-systolic volume; LVEF: Left ventricular ejection fraction; SAS: Self-Rating Anxiety Scale.

Multiple regression analysis of echocardiographic indicators in patients with CHD

A multiple regression analysis was performed using changes in echocardiographic parameters as dependent variables, including increased LVEDD (0 = No, 1 = Yes; normal clinical range: 35-55 mm), increased LVESV (0 = No, 1 = Yes; normal clinical range: 0-50 mL), increased LVEDV (0 = No, 1 = Yes; normal clinical range: 75-160 mL), and decreased LVEF (0 = No, 1 = Yes; normal clinical range: 55%-75%). After adjusting for confounding factors such as age, gender, smoking history, alcohol consumption history, myocardial infarction history, and NYHA classification, the results showed that both the Gensini and SAS scores were independent risk factors for increased LVEDD, LVESV, and LVEDV, as well as decreased LVEF in patients with CHD (P < 0.05; Table 6).

Table 6 Multiple regression analysis results of echocardiography indicators affecting coronary heart disease patients.

Project	Model1			Model2
	β	95%CI	P value	β	95%CI	P value
LVEDD
Gensini score	0.348	0.205-0.456	0.018	0.335	0.1730.430	0.023
SAS score	0.225	0.128-0.519	0.029	0.203	0.0910.425	0.032
LVESV
Gensini score	0.317	0.199-0.626	0.021	0.265	0.1630.545	0.024
SAS score	0.239	0.158-0.453	0.017	0.194	0.118-0.437	0.026
LVEDV
Gensini score	0.359	0.149-0.626	0.028	0.394	0.182-0.729	0.014
SAS score	0.267	0.102-0. 464	0.024	0.178	0.053-0.415	0.033
LVEF
Gensini score	-0.094	-0.283 to - 0.054	0.038	-0.079	-0.274 to -0.053	0.044
SAS score	-0.126	-0.325 to - 0.034	0.042	-0.058	-0.186 to -0.025	0.047

¹Model: Analysis results without adjusting for covariates.

²Model: Analysis results after adjusting for age, gender, smoking history, alcohol consumption history, myocardial infarction history, and New York Heart Association classification.

LVEDD: Left ventricular end-diastolic diameter; LVEDV: Left ventricular end-diastolic volume; LVESV: Left ventricular end-systolic volume; LVEF: Left ventricular ejection fraction; SAS: Self-Rating Anxiety Scale; CI: Confidence interval.

DISCUSSION

Patients with CHD generally experience anxiety and other negative emotions during the examination process. These emotional responses may arise from various factors, such as the patients’ uncertainty about their condition due to non-specific symptoms such as chest tightness and pain[11], or psychological stress related to concerns about CHD prognosis[12]. CAG and echocardiography are commonly used for clinical evaluation of CHD. Previous studies have shown that anxiety and depression can affect the accuracy and effectiveness of CAG examinations[13-15]. However, limited research has examined the relationship between echocardiographic indicators and negative emotions in patients with CHD. Therefore, when analyzing the relationship between echocardiographic parameters and coronary artery disease, it is also important to explore their relationship with patients’ emotional states.

CAG requires the injection of a contrast agent and X-ray imaging, which exposes patients to radiation. In contrast, echocardiography offers a noninvasive, radiation-free, and convenient alternative for visually assessing cardiac structures, including vascular features and valve morphology. Parlavecchio et al[16] reported that echocardiography demonstrates high accuracy and specificity in diagnosing coronary artery lesions. In patients with CHD, increased LVEDD indicates chronic dilation of the left ventricle; elevated LVESV and LVEDV reflect a decline in systolic functional reserve; and decreased LVEF suggests impaired systolic function of the left ventricle. This study found significant differences in LVEDD, LVESV, LVEDV, and LVEF across groups with varying severities of coronary artery lesions. As lesion severity increased, LVEDD, LVESV, and LVEDV values increased significantly, while LVEF decreased. These findings may be attributed to the ability of echocardiography to evaluate cardiac structure, function, and blood flow[17] and to effectively detect myocardial ischemia and valvular dysfunction[18]. This study also found that the Gensini score of patients with CHD was positively correlated with LVEDD, LVESV, and LVEDV and negatively correlated with LVEF. After adjusting for confounding factors, a higher Gensini score remained an independent risk factor for increased LVEDD, LVESV, and LVEDV values and for decreased LVEF. The underlying mechanism may involve reduced myocardial blood flow due to coronary artery stenosis. To maintain adequate cardiac output - particularly under increased preload - the heart compensates by expanding the ventricular cavity (increasing LVEDV) to enhance contractility through the length-tension relationship. Additionally, ischemia-induced ventricular dilation occurs as the ventricle expands under pressure, prompting the non-ischemic myocardium to undergo eccentric hypertrophy to preserve stroke volume. This process leads to an overall enlargement of the ventricular cavity, reflected by increased LVEDD and LVEDV. Chronic hypoperfusion from sustained stenosis further promotes cardiac remodelling and myocardial damage, ultimately impairing cardiac function and reducing LVEF.

Multiple studies have confirmed that anxiety levels in patients with CHD are significantly higher than those in the general population[19-21]. CHD accompanied by anxiety is often associated with more pronounced cardiac structural remodelling (e.g., increased LVEDD and LVEDV) and functional decline (e.g., decreased LVEF)[22], as well as poorer prognoses (including higher rates of rehospitalization and mortality). This study found significant differences in LVEDD, LVESV, LVEDV, and LVEF among patients with CHD experiencing different levels of anxiety. As anxiety increased, LVEDD, LVESV, and LVEDV values increased, while LVEF decreased. Anxiety, as a negative emotional state, can disrupt the balance of autonomic nerve function through neurohumoral regulation or the adrenal axis. Persistent sympathetic activation leads to excessive release of catecholamines (adrenaline and noradrenaline), resulting in increased heart rate, blood pressure, and cardiac workload. For patients with severe anxiety, dysregulation of cardiovascular reflexes involving pressure receptors, chemical receptors, and cardiopulmonary receptors can cause an imbalance in the autonomic nervous system, leading to changes in heart rhythm disturbances. These changes increase cardiac workload and contribute to declining cardiac function. These findings suggest that the anxiety in patients with CHD may influence echocardiographic parameters. Spyra et al[23] reported correlations between mental disorders, including anxiety and depression, and echocardiographic measures. Ma et al[24] found a negative correlation between LVEF and anxiety in patients with heart failure, indirectly supporting the present results. This study further showed that the SAS score in patients with CHD was negatively correlated with LVEF and positively correlated with LVEDD, LVESV, and LVEDV. After adjusting for confounding factors, a higher SAS score remained an independent risk factor for increased LVEDD, LVESV, and LVEDV, as well as decreased LVEF. The underlying mechanism may involve anxiety-induced sympathetic activation, hypothalamic-pituitary-adrenal axis dysfunction, and systemic inflammatory responses[25], which increase cardiac workload and promote ventricular remodelling, resulting in detectable structural and functional changes on echocardiography. The underlying mechanism may involve several pathways. First, anxiety induces sustained sympathetic activity, increasing cardiac workload, accelerating heart rate, and elevating blood pressure, which impairs ventricular relaxation and reduces both contractile and diastolic function. Anxiety also disrupts the hypothalamic-pituitary-adrenal axis function, resulting in increased cortisol levels, immune imbalance, and inflammatory responses. These changes impair vascular endothelial function, reduce vasodilation, compromise cardiac perfusion, and ultimately contribute to ventricular remodelling and systolic dysfunction. Second, CHD inherently involves structural cardiac changes. When combined with anxiety, this can exacerbate ventricular remodelling - manifested as increased LVEDD, LVESV, and LVEDV - and further impair cardiac function, reflected by reduced LVEF[26]. Additionally, symptoms arising from CHD-related structural changes, along with concerns about disease progression and decreased quality of life, may further worsen anxiety. These findings highlight the importance for clinicians to consider the close relationship between anxiety and echocardiographic indicators of ventricular remodelling and cardiac function in patients with CHD. Anxiety not only contributes to ventricular remodelling and impaired cardiac function in patients with CHD but also influences adverse clinical outcomes. Therefore, in clinical practice, assessment and management of psychological and social factors - especially anxiety - should be integrated into comprehensive CHD treatment to improve cardiac structure and function, alleviate symptoms, and enhance prognosis. A recommended approach includes the following: Routine anxiety screening at admission (using anxiety scale assessments), risk stratification, integration of objective findings (echocardiographic parameters) with subjective symptoms (e.g., chest tightness and palpitations), and clinician-patient discussions to guide interventions. These interventions may include stress management education, promotion of physical activity, mindfulness and breathing exercises, and other psychologically oriented strategies aligned with patient-centred care.

This study had several limitations. First, this study used a retrospective cross-sectional design, collecting data at a single time point or over a short period, which limits the ability to infer causal relationships and only allows identification of associations. Second, data were collected from a single centre with a relatively small sample size. Future research should involve multicenter, prospective studies with larger populations to validate and expand these findings.

CONCLUSION

Echocardiographic indicators are significantly associated with coronary artery lesions and anxiety in patients with CHD. When using echocardiography as a noninvasive tool to guide clinical management, clinicians should consider the influence of patient anxiety on echocardiographic measurements. Therefore, it is recommended to take measures to alleviate anxiety in order to improve the accuracy of clinical treatment guided by echocardiography.