Depressive symptoms are associated with mental stress-induced myocardial ischemia after acute myocardial infarction.

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.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.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.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

Mean unadjusted myocardial perfusion ischemic defect severity [raw summed difference score (SDS)] with mental stress according to five groups of progressively higher depressive symptoms using quintiles of the BDI-II total score.

<p>The error bars represent standard errors. The p-value is from a linear regression model where quintiles of the BDI-II score were modeled as an ordinal variable. There was a statistically significant progressive increase in mental stress-induced myocardial ischemia with increasing depressive symptom severity.</p

Mean unadjusted myocardial perfusion ischemic defect severity [raw summed difference score (SDS)] with physical (exercise or pharmacological) stress according to five groups of progressively higher depressive symptoms using quintiles of the BDI-II total score.

<p>The error bars represented standard errors. The p-value is from a linear regression model where quintiles of the BDI-II score were modeled as an ordinal variable. There was no statistical difference in physical stress-induced myocardial ischemia with increasing depressive symptom severity. No association was also found when non-parametric regression with smoothing splines was used to model a non-linear association.</p

Association between BDI-II somatic and cognitive symptom scores and myocardial ischemia severity with mental stress, as quantified by the SDS.

<p>Abbreviations: BDI-II: Beck Depression Inventory-II; SDS: summed difference score; CI: confidence interval; CAD: coronary artery disease.</p>†<p>The β coefficient expresses the difference in SDS score points with a 1-point increase in BDI-II total score. Each model was constructed with SSS as dependent variable adjusting for the rest score (SRS). SE: standard error.</p>‡<p>Sex, employment, race, marital status and cigarette smoking.</p>§<p>Gensini angiographic CAD severity score, left ventricular ejection fraction, hypertension, diabetes, BMI, previous revascularization procedures, use of statins, beta-blockers, and anti-depressants.</p

Association between depressive symptoms (BDI-II total score) and myocardial ischemia severity, as quantified by the SDS with mental stress and with physical (exercise or pharmacological) stress.

<p>Abbreviations: BDI-II: Beck Depression Inventory-II; SDS: summed difference score; CI: confidence interval; CAD: coronary artery disease.</p>†<p>The β coefficient expresses the difference in SDS score points with a 1-point increase in BDI-II total score. Each model was constructed with SSS as dependent variable adjusting for the rest score (SRS). SE: standard error.</p>‡<p>Sex, employment, race, marital status and cigarette smoking.</p>§<p>Gensini angiographic CAD severity score, left ventricular ejection fraction, hypertension, diabetes, BMI, previous revascularization procedures, use of statins, beta-blockers, and anti-depressants.</p

Abstract 16623: Elevated Depressive Symptoms Help Predict Major Adverse Cardiovascular Outcomes Irrespective of History of Depression

Background: Although a clinical diagnosis of depression has been associated with worse long term outcome in patients with cardiovascular disease (CVD), whether patients who have elevated depressive..