What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Acute Myocardial Infarction (n=98). Intervention: Depressive symptoms (BDI-II score). Primary outcome: Mental stress-induced myocardial ischemia severity (Summed Difference Score) (b = 0.14, 95% CI 0.03-0.24, p=0.01).

July 25, 2014Open Access

Depressive Symptoms Are Associated with Mental Stress-Induced Myocardial Ischemia after Acute Myocardial Infarction

Q: What does this research mean for the field?

Higher depressive symptoms are associated with increased mental stress-induced myocardial ischemia in young post-MI patients, with each 1-point increase in BDI-II score yielding a 0.14-point increase in ischemia severity. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

Higher depressive symptoms were associated with increased mental stress-induced myocardial ischemia, with each 1-point increase in BDI-II score yielding a 0.14-point increase in ischemia severity.

Study Design

Type

Cross-Sectional (n=98)

Multicenter

Yes

Structured PICO

Are depressive symptoms associated with mental stress-induced myocardial ischemia in young survivors of an acute myocardial infarction?

Population

98 patients (49 women, 49 men) age 38-60 years (mean/median age 50) hospitalized for acute myocardial infarction in the previous 6 months. 55% African-American. Key exclusions: unstable angina or acute MI within the past week, severe comorbid medical or psychiatric disorder, weight over 400 pounds, pregnant/breastfeeding, or unable to exercise on a treadmill (DASI <5 METs).

Intervention

Assessment of depressive symptoms using the Beck Depression Inventory-II (BDI-II) questionnaire, followed by mental stress testing (standardized public speaking task) and physical stress testing (exercise or pharmacological with 0.4 mg IV regadenoson).

Outcome

Myocardial ischemia severity under mental stress and physical stress, quantified by a summed difference score (SDS) using SPECT myocardial perfusion imaging with 99mTc sestamibi.surrogate

In young post-MI patients, higher levels of depressive symptoms are significantly associated with a greater propensity for mental stress-induced myocardial ischemia, but not physical stress-induced ischemia.

Main Result

Effect estimate: b = 0.14 (95% CI 0.03-0.24)

p-value: p=0.01

Limitations

Small sample size which may decrease statistical power
Restricted to young post-MI patients, limiting generalizability to older or other CAD populations
Lack of data linking mental stress ischemia to clinical outcomes

Abstract

OBJECTIVES: Depression 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. METHODS: We 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. RESULTS: There 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. CONCLUSION: Among 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.

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