Depressive Symptoms are Associated with Mental Stress-Induced Myocardial Ischemia after Acute Myocardial Infarction Open Access

Wei, Jingkai (2014)

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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 through 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 exercise/pharmacological stress.

Table of Contents

Table of Contents

Chapter I: Background. 1

Chapter II: Manuscript 5



Subjects. 6

Study Design. 7

Mental Stress Procedure. 7

Myocardial Perfusion Imaging. 7

Measurements of Depressive Symptoms. 9

Other Measurements. 9

Statistical Analysis. 10


Study Sample. 11

BDI-II Scores. 11

Myocardial Perfusion. 11

Association of Depressive Symptoms with SDS (Ischemia Score) 12


Chapter III: Summary, Public Health Implications, Possible Future Directions. 17



Table 1. Mean depressive symptoms (BDI-II total score) according to patients characteristics. 28

Table 2. Association between BDI-II total score and myocardial perfusion ischemia severity (SDS) with mental stress and physical stress. 30

Table 3. Association between BDI-II somatic and cognitive symptom scores and myocardial perfusion ischemia severity (SDS) with mental stress. 31


Figure 1. 32

Figure 2. 33

Figure 3. 34

Figure 4. 35

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