Abstract
ObjectivesDepression is an adverse prognostic factor after an acute myocardial infarction (MI), and an increased propensity toward emotionally-driven myocardial ischemia may play a role. We aimed to examine the association between depressive symptoms and mental stress-induced myocardial ischemia in young survivors of an MI.MethodsWe studied 98 patients (49 women and 49 men) age 38–60 years who were hospitalized for acute MI in the previous 6 months. Patients underwent myocardial perfusion imaging at rest, after mental stress (speech task), and after exercise or pharmacological stress. A summed difference score (SDS), obtained with observer-independent software, was used to quantify myocardial ischemia under both stress conditions. The Beck Depression Inventory-II (BDI-II) was used to measure depressive symptoms, which were analyzed as overall score, and as separate somatic and cognitive depressive symptom scores.ResultsThere was a significant positive association between depressive symptoms and SDS with mental stress, denoting more ischemia. After adjustment for demographic and lifestyle factors, disease severity and medications, each incremental depressive symptom was associated with 0.14 points higher SDS. When somatic and cognitive depressive symptoms were examined separately, both somatic [β = 0.17, 95% CI: (0.04, 0.30), p = 0.01] and cognitive symptoms [β = 0.31, 95% CI: (0.07, 0.56), p = 0.01] were significantly associated with mental stress-induced ischemia. Depressive symptoms were not associated with ischemia induced by exercise or pharmacological stress.ConclusionAmong young post-MI patients, higher levels of both cognitive and somatic depressive symptoms are associated with a higher propensity to develop myocardial ischemia with mental stress, but not with physical (exercise or pharmacological) stress.
Highlights
Depression is a prevalent, debilitating, and underdiagnosed condition that affects approximately 20% of patients with recent myocardial infarction (MI), and is associated with increased risk of recurrent cardiac events [1]
We addressed the hypothesis that an increased level of depressive symptoms is a risk factor for mental stress-induced ischemia, but not for exercise/pharmacological stress-induced ischemia
Patients were excluded if they were unable to exercise on a treadmill, based on a score,5 metabolic equivalents (METs) on the Duke Activity Status Index (DASI), which identifies patients who cannot exercise to heart rate targets [15]
Summary
Depression is a prevalent, debilitating, and underdiagnosed condition that affects approximately 20% of patients with recent myocardial infarction (MI), and is associated with increased risk of recurrent cardiac events [1]. Ischemia induced by psychological stress is a common phenomenon in stable CAD patients [9] and is associated with a doubling of risk of cardiac events and death [10]. This phenomenon can be studied experimentally in the laboratory by using a standardized mental stress test [11], but it has rarely been evaluated with respect to depression
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