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Clinical Trial
. 2013 Nov-Dec;75(9):822-31.
doi: 10.1097/PSY.0b013e3182a893ae. Epub 2013 Oct 25.

Depressive symptoms and mental stress-induced myocardial ischemia in patients with coronary heart disease

Stephen H Boyle  1 , Zainab Samad, Richard C Becker, Redford Williams, Cynthia Kuhn, Thomas L Ortel, Maragatha Kuchibhatla, Kevin Prybol, Joseph Rogers, Christopher O'Connor, Eric J Velazquez, Wei Jiang
Affiliations
Clinical Trial

Depressive symptoms and mental stress-induced myocardial ischemia in patients with coronary heart disease

Stephen H Boyle et al. Psychosom Med. 2013 Nov-Dec.

Abstract

Objectives: The aim of this study was to examine the associations between depressive symptoms and mental stress-induced myocardial ischemia (MSIMI) in patients with coronary heart disease (CHD).

Methods: Adult patients with documented CHD were recruited for baseline mental stress and exercise stress screening testing as a part of the enrollment process of the Responses of Myocardial Ischemia to Escitalopram Treatment trial. Patients were administered the Beck Depression Inventory II and the Center for Epidemiologic Studies Depression Scale. After a 24-48-hour β-blocker withdrawal, participants completed three mental stress tests followed by a treadmill exercise test. Ischemia was defined as a) any development or worsening of any wall motion abnormality and b) reduction of left ventricular ejection fraction at least 8% by transthoracic echocardiography and/or ischemic ST-segment change by electrocardiography during stress testing. MSIMI was considered present when ischemia occurred in at least one mental test. Data were analyzed using logistic regression adjusting for age, sex, and resting left ventricular ejection fraction.

Results: One hundred twenty-five (44.2%) of 283 patients were found to have MSIMI, and 93 (32.9%) had ESIMI. Unadjusted analysis showed that Beck Depression Inventory II scores were positively associated with the probability of MSIMI (odds ratio = 0.1.30: 95% confidence interval = 1.06-1.60, p = .013) and number of MSIMI-positive tasks (all p < .005). These associations were still significant after adjustment for covariates (p values <.05).

Conclusions: In patients with CHD, depressive symptoms were associated with a higher probability of MSIMI. These observations may enhance our understanding of the mechanisms contributing to the association of depressive symptoms to future cardiovascular events. Trial Registration Clinicaltrials.gov identifier: NCT00574847.

Keywords: coronary heart disease; depressive symptoms; exercise-induced myocardial ischemia; mental stress–induced myocardial ischemia.

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Figures

Figure 1a
Figure 1a
Probability of MSIMI as a function of BDI-TOT score by number of MSIMI episodes. Odd ratios (ORs) were expressed as a comparison of the 75th and 25th percentiles of the BDI-TOT scale.
Figure 1b
Figure 1b
Probability of MSIMI as function of BDI-SA scores by number of MSIMI episodes.
See this image and copyright information in PMC

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References

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